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Showing newest 18 of 29 posts from March 2008. Show older posts
Showing newest 18 of 29 posts from March 2008. Show older posts

Wednesday, March 26, 2008

For PubMed haters, new solutions emerging

It is possible that I am about to preach to the choir, but I am going to come right out and say it anyway. I hate PubMed. I hate it with a burning passion. For a site that is as vital to scientific progress as PubMed is, their search engine is shamefully bad. It’s embarrassingly, frustratingly, painfully bad.
So begins Harvard scientist Anna Kushnir's against , the US National Library of Medicine's medical publications web search engine. ("Can I even call it an engine?" asks Ms Kushnir in the post on her blog . "It’s more like a tricycle.")

Ms Kushnir is not alone in her disdain for the ubiquitous website. "I hate you Pubmed. I hate you with a passion so great it defies existence," . "I HATE PUBMED AND MEDLINE!!! becos it's so frigging hard to find anything useful," has said, apparently too incensed to even use spell-check.

What's with all the PubMed hate?

Well, some of the complaints include -- but are by no means limited to -- the following:
  • failing to return an obvious result
  • returning too many results
  • getting mixed up between authors' first and last names
  • getting even more mixed up when there are multiple authors by the same name
  • the difficulty of keeping up to date on a certain topic using its search function
  • its opaque search methodology
  • its occasionally incomplete article titles
  • the number of journals it indexes
  • and just being confusing in general.
To name just a few.

"Science cannot proceed at a decent clip if researchers cannot find the most basic necessary information," writes Ms Kushnir, and really, who could argue?

Many researchers have decided to give up on PubMed altogether and have begun looking for alternatives. There's , , and . Others have been working on different ways to use and display the data available through PubMed, such as , and .

But, as it turns out, PubMed has anticipated much of the competition and already introduced a solution in 2005 to help users who want to stay updated on a particular topic. It's now possible, as this explains, to get alerts when a new item appears that matches your search terms, using Really Simple Syndication, or RSS. For instance, you can check out my RSS feed for articles about "monkeys in space" . (I know that's maybe not the most useful search imaginable, but you never know what NASA is working on. I actually do use one very useful PubMed RSS feed using that picks up all new studies that refer to officially registered clinical trial data.)

Anna Kushnir's strongly worded complaint about PubMed even elicited a reply from Dr David J Lipman of the National Center for Biotechnology Information, which helps operate PubMed. His message was in the comments section below Ms Kushnir's rant:
Although the current engine works well for some users and some queries, I understand Anna’s frustration and we are in the midst of a number of changes that will make PubMed work better for her and many other users. One type of query she is doing – essentially a form a targeted search/citation matching – will be handled much better within the next couple of weeks. We’re putting in a CitationSensor approach that will run the default search (but one which is itself somewhat improved) but have a separate set of heuristics for picking up Anna’s type of query.

Especially for someone writing a thesis or paper, they are often simply trying to find a particular paper, perhaps using author names, or terms from a title, or even just cutting & pasting a reference from another online paper. So this will be a big improvement for them.

We will be adding a number of other “sensors” which will run in parallel with the default search. From monitoring results of enhancements we’ve added to some of our other Entrez databases, it’s clear that users will be taking advantage of this.

A number of these complaints are fair and we’ll be doing our best to address them. With the large number of users we have, it will be clear what areas we’ll improving and what areas will need more work. And wish her good luck on her defense!
Good news for friends of PubMed and PubMed haters alike! The times they are a-changin' for biomedical research database searches.

What do you think?








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Tuesday, March 25, 2008

You were searching for WHAT?!

Browsing through the list of search terms that have led readers to our blog is sometimes amusing, often disturbing and always very strange.

I've collected some of the web searches that have led readers to Canadian Medicine, organized thematically. The terms, perhaps unsurprisingly, fall neatly into categories that mirror the great themes of human experience: death, love, crime, crack pipes, etc. Each set of search terms tells a compelling story -- one that reflects the zeitgeist of our times, I think.

LOVE
marry a canadian
marry a canadian man
marry a canadian for healthcare
americans wanting to marry canadians for healthcare
american cancer patients looking to marry canadians
canadian babes
american babes
script love story
the best of canadian male and sick wife 2008
drunk wifes

DEATH
way to die
the best way to die
carbon monoxide painful way to die
american doctor kill
breastfeeding death
mummified baby
how to kill a skunk

SEX
doctor medicine gay
doctor medicin gay
doktor medicine gay
homosexual medical experiments
pleasure high heels
using high heels for sexual pleasure
body modification high heels

CRACK PIPES
crack pipes
benefits of crack pipe
clean crack
how to clean a crack pipe
crack pipe filters 2008
diseases caused by crack pipes prices and photos
man killed with pipe 2007 vancouver
buy a crack pipe in vancouver

CRIME
canada, arson, six months
canadian law threatening

ACCUTANE
2 rounds of accutane failed
accutane birth defects in saskatchewan how long should you wait before getting pregnant
accutane is a good medicine
does accutane make you hungry

?
digital rock imaging
how to make a fire with 2 medicines
brainsuckers are hungry

And finally, this:
dr sam solomon montreal

I appreciate the sentiment from whoever typed that into their search engine, but the College of Physicians and Surgeons might not appreciate having a journalist seeing patients.


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Monday, March 24, 2008

Canada's Next Great Prime Minister: a Métis Saskatchewan doctor

Remember that CBC reality TV show, "Canada's Next Great Prime Minister" -- the one in which overeager university student know-it-alls vie for the attention of a handful of somewhat distracted now-unemployed ex-PMs like Kim Campbell and John Turner?

You don't? Well, you're not alone. It's , and I would have forgotten it existed at all if not for the fact that this year's winner is a 25-year-old Métis Saskatchewan doctor, Alika Lafontaine. His proposal to get aboriginal Canadians more engaged in government proved key to his victory over the other exceptionally earnest contestants. Watch his impassioned plea to add a third house of government to Canada's parliamentary system, the Aboriginal House:



Dr Lafontaine says he wants to get involved in federal politics but doesn't have a party yet. Unfortunately for him, he may have already blown his chances at running for the Liberals.

One Canwest News reporter :

When Lafontaine was asked by host Rick Mercer what he as prime minister would do if faced with a Quebec referendum won by a slim 900-vote margin, he said he would recognize the will of the Quebec people but was subsequently pounced on by former prime minister and staunch federalist Quebec MP Paul Martin.

"That will stick with me - the fact that Mr. Martin disagreed so vehemently about Quebec," Lafontaine said. "I was unprepared for the question but I said what I thought... The democratic process, it really is the majority. We have to respect that. I may have been too strong in my wording."
He's not from Quebec, so I guess he still has a lot to learn about the dynamics of the federalist-separatist issue. But pissing off Paul Martin before you even start your political career? Not a good omen.

Dr Lafontaine's story is quite a touching one, federalist doubts aside. He was diagnosed with hearing and learning disabilities as a child. His parents home-schooled him and he overcame the odds, earning a university degree by the time he was 19.

As a form of payment for suffering through days of filming with Rick Mercer, Mr Martin, Mr Turner, Ms Campbell and Newfoundland & Labrador premier Danny Williams, Dr Lafontaine walks away with a cool $50,000.

For more about Dr Lafontaine, you can check out his blog, , or consult . His username is Saskdoc, and he lists his interests as follows:
Country: Canada
Occupation: Physician - Anesthesia Resident
Interests and Hobbies: Running, Cooking and collecting useless facts...I think I'd be good on Are you smarter than a 5th grader!
Movies and Shows: Law and Order, Heroes, Simpsons (Season 4-6 were the best), The Daily Show
Music: Soul, Folk, Pop, Hip-Hop
Books: Julius Cesar, old skool Hardy Boys, all those Choose your own Adventure books, reading the Talmage series as of late...I sometimes pretend my medical textbooks are fun to read...but they're not. :P
That trope -- disillusionment with the field of medicine, even as he is just beginning -- seems to reappear throughout his writing online. Just check out this sort of depressing little snippet from the autobiographical note on his blog (with another oddly placed tongue-sticking-out emoticon):
I should have stopped after the BSc. :P
Maybe medicine isn't for you, Dr Lafontaine? But one piece of advice before you make the jump to politics: get clear on the .


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Debut of James Orbinski documentary set for April in Toronto

The largely unheralded Canadian hero of international medical relief and tireless humanitarian advocate, Dr James Orbinski, is the subject of an excellent new documentary titled Triage, which will see as part of Toronto's HotDocs festival. Here's a short clip from the film:



I recently watched Triage and spoke to Dr Orbinski about his time as president of Médecins sans frontières (MSF) and his new book, , and I highly recommend both the film and the book. (My interview with Dr Orbinski will appear in a forthcoming issue of the .)

Triage is unlikely to see any kind of wider release beyond the festivals, I suspect, and that's really a shame. It's a powerful documentary; the camera follows Dr Orbinski as he returns to the scenes of genocides and massacres he witnessed in Somalia and Rwanda. The filmmakers manage to capture both the intellectual and the emotional aspects of Dr Orbinski's experience working in war zones with MSF and later as its president -- a job that in 1999 earned the organization the Nobel Peace Prize. (Read Dr Orbinski's Nobel lecture .)

In case you can't make it to Toronto for HotDocs, Triage will be shown on Global later this year.

If you do manage to hit up HotDocs, however, don't miss this other medically themed flick, , about a neurosurgeon named Henry Marsh who decided in the 90s to improve on poor brain surgery techniques in Ukraine -- by grabbing a power drill from the hardware store and getting down to work. Acknowledging the questionable ethics behind Dr Marsh's decision (his drill ran out of batteries during one operation), Graeme Wood of The Atlantic the man and the film.


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Thursday, March 20, 2008

Putting the experts on the hot seat

We've been conducting Q&As with medicine's movers and shakers for the front page of the National Review of Medicine for well over a year now. Here are some of the most popular interviews:

Sanjay Gupta, CNN journalist and neurosurgeon
He's a neurosurgeon, an author and an Emmy Award-winning reporter. And he's not yet 40. CNN's chief medical correspondent Dr Sanjay Gupta has covered some of this era's worst disasters, from Hurricane Katrina to the 2005 tsumani, and has become America's most trusted medical news source. NRM about stem cells, the war in Iraq and his sexiest man alive rivalry with CNN's Anderson Cooper.

Stéphane Dion, federal opposition leader
Stéphane Dion, the embattled leader of the Liberal Party, put his political future on the line last week. After some tough talk, he backed down and supported Prime Minister Stephen Harper's contentious Throne Speech to avoid sending Canadians to the polls. NRM reached Mr Dion by email before the Throne Speech to about Stephen Harper, tax cuts, wait times — and Céline Dion.

Roundtable discussion: Michael Moore
Michael Moore's big-screen portrait of Canada's healthcare system in his 2007 film SiCKO has been hailed by some as a welcome testament to the strengths of Canadian health equality. Others accuse him of glossing over our problems to glorify universal healthcare. NRM assembled a panel of respected Canadian and American health policy experts to .

Tony Clement, federal health minister
Despite his famous nickname, federal health minister 'Two-tier' Tony Clement says he has no plans to rewrite the Canada Health Act. The man who cut his teeth fighting SARS and pioneering P3s as Ontario's health minister is now on a mission to slash the country's wait times. NRM , yes, about wait times — and then we threw him some curveball questions from our readers.

Dr Dave Williams, NASA astronaut

Astronaut and physician Dave Williams made one giant leap for Canuck-kind in August when he set the record for the most spacewalks by a Canadian. The Saskatchewan-born former emerg doc has made his mark at NASA as a telesurgery pioneer, performing operations under the sea in preparation for the eventual Mars mission. at the Johnson Space Center in Houston to talk about extraterrestrial medicine, space sex and 2001: A Space Odyssey.

Dr Gunther von Hagens, Body Worlds creator
Dr Gunther von Hagens' Body Worlds exhibitions of plastinated human bodies have wowed — and revolted — people the world over. The unconventional German anatomist and physician was on hand when his new show Body Worlds 2 opened in Montreal last year. Before leaving for Germany, he about black hats, James Bond and how many pieces he'll be cut into when he dies.

Dr Brian Day, Canadian Medical Association president
Dr Brian Day, the country's most notorious private-healthcare advocate, is now at the helm of the Canadian Medical Association. But is he really sounding the death knell of medicare? The wait list-obsessed Liverpudlian surgeon took a break from his presidential duties to about Canada in denial, dining with Jacques Chaoulli and his short-lived boxing career. Plus we put him on the spot with tough questions from our readers.

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Canadian Medicine's Medscape cameo

I was recently interviewed by Dr Nick Genes for the US-based health information and CME website Medscape. You can read the full interview . (Registration is required, but it's free and a pretty quick process.)

I'm an American-born Canadian dual citizen, so Dr Genes and I spent much of the interview discussing the differences between the American and Canadian healthcare systems. We talked about common misperceptions from each side of the border. "Canadians tend to think of the American healthcare system as entirely privatized and scary, and Americans tend to think of the Canadian system as entirely public and scary," I told him. We also talked about the current state of medical publishing and health journalism.

I encourage you all to check it out . And, if you're so inclined, let me know what you think of the debate about which healthcare system is better: the American one, or the Canadian?


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Dr Alain Beaudet named new CIHR president

Dr Alain Beaudet, a Montreal physician and neuroscience researcher, will be the new president of the Canadian Institutes of Health Research (CIHR), Health Minister Tony Clement today.

There's no doubt the job is a tough one -- a balancing act between money, science and politics -- and medical researchers will now begin asking whether Dr Beaudet is up to the task.

The current president and CEO of the Quebec government's medical research funding agency, called , Dr Beaudet takes over for acting president Dr Pierre Chartrand. Dr Chartrand has been filling in since longtime CIHR head Alan Bernstein to take a job as executive director of the Global HIV Vaccine Enterprise. Dr Bernstein's presidency ; he complained of having been made a "scapegoat" by members of the Canadian medical research community who were bitter over declining success rates for their grant proposals and -- what else? -- their desire for more money. Dr Bernstein later refuted that characterization of his departure from CIHR in a of the CMAJ, but didn't address the discrepancy in tone between his initial comments and his later statement about his "great pride" in the organization.

So, is Dr Beaudet tough enough to handle the Canadian government bureaucracy?

Based on his biography, Dr Beaudet looks like a good appointment. Besides today's CIHR appointment, he's had a whole bunch of major endorsements of late. The Université Pierre et Marie Curie, in France, (PDF) in December of last year, and last June the French Consul General in Quebec City gave him the Order of Academic Palms's distinguished Officer's award, a tradition begun by none other than Napoleon himself. Why so popular in the old country, you ask? He did his postdoctoral work there, as well as in Switzerland, and he continues to collaborate with neuroscience researchers in Paris and Nice. "Lastly," adds from the Quebec government, "he has collaborated with French biotechnology firms, including Biocom, specialized in cell-imaging software development. Dr. Beaudet has also made outstanding contributions to teaching and training; in addition to his Québec students, he has trained many postdoctoral fellows from France."

And get this. Dr Beaudet is one helluva scientist: he's got a whopping 491 publications listed under his name, . And I can't understand a word of it, except for the occasional preposition or conjunction. His most recent, online first in BMC Genomics in January, is titled, "Genomic analysis of the chromosome 15q11-q13 Prader-Willi syndrome region and characterization of transcripts for GOLGA8E and WHCD1L1 from the proximal breakpoint region."

Even though his work is way beyond my comprehension, naming such an active and world-famous researcher -- and one with a medical degree, unlike the last two people to have held the position -- as president of the nation's medical research funding agency sure seems like a good choice.

What do you think of the selection? And what do you think Dr Beaudet's priorities should be at CIHR?


Photo: , British Columbia

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Top 3 posts of the week by Canadian doctor-bloggers

What's going on this week in the Canadian physician blogosphere?

(Note to self: opportunity for new coinage. Phlogosphere? Physlogosphere? Physiblogiciansphere? Perhaps not.)

Here are the week's top posts:

1. "" by Nunavut's own Dr J, Adventures in Medicine. An excerpt:

My own agenda for the visit is to discuss his wishes around extent of treatment and end of life care. The patient in front of me has end stage COPD and it seems an important thing to clarify. In hospitals this is framed as a DNR discussion, but here it is much more. It is a discussion about values, beliefs, and a cultural divide that at times seems as vast as the arctic itself. The current group of Inuit elders are the last Inuit people who were mainly born and grew up living on the land (that is; living a traditional nomadic lifestyle centered around hunting and survival). They are pragmatists, and when asked if they wish any particular medical intervention the usual response is 'yes, if that is what you think needs to be done'. When I first arrived in the north I had a few DNR discussions in the usual southern style, and they didn't go too well. Like they had talked about in medical school I asked the patients if their heart were to stop would they like us to try to restart it, even though the chance of success was small given their particular condition. They would look at me quizzically and through the interpreter say 'Of course he wants that, if he would die or live he wants to live. Now he wants to not talk about that anymore!'. It took me a few go-rounds to catch onto the fact that I was having the wrong conversation.
2. "" by Dr Martina Scholtens, FreshMD.
I use an interpreter for the Spanish-speaking patients at the clinic, and sangria is one word that I hear regularly. It's usually buried in a long descriptive passage by the patient, and while I'm waiting for the English version, I think of a chilled red wine beverage with brandy and floating citrus slices.
Finally, I asked the translator why the word kept cropping up. Turns out sangria means bleeding, and my pleasant reveries are completely at odds with the experiences the patients are recounting. I think I may even have been smiling while someone described a hemorrhage.
sangria means: "alcoholic punch made from red wine mixed with fruit juice and soda water; bend; indentation; bleeding; phlebotomy, drawing blood for medical purposes." Makes sense when you think about it, considering sang is French for blood, and exsanguination is English for what happens during hypovolemia: the loss of blood. But, like Dr Scholtens, I hadn't before thought in such detail about the connection between Spanish cocktails and ways to die.

3. "" by Dr Yoni Freedhoff, Weighty Matters. Dr Freedhoff's reaction to that the University of Guelph will offer a four-year degree in the fitness and nutrition issues related to obesity:
For me, this hammers home two messages:

Firstly, that clearly there's a crying need for more health professionals trained in obesity management.

Secondly, that medical schools and residency programs are failing our obese patients.

Frankly in an ideal world, I don't think obesity management should be a University course. The reason you don't see 4 year degrees in blood pressure or diabetes is because doctors are taught how to adequately manage those conditions in medical school and residency. Unfortunately the same cannot be said for obesity.

In my ideal world obesity medicine would be a sub specialty program within the department of Family Medicine and/or a real 5 year physician specialist program.

If you're interested in the course, you'd better have good grades - they've already received 430 applications for the 60 available spots.


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Wednesday, March 19, 2008

Does Canada need more med schools?

In journalism, a single instance of something is unremarkable. Two instances? That's more interesting but still not quite newsworthy. Three's the magic number, like in Goldilocks, baseball and Schoolhouse Rock. Once you hit three -- boom! -- you've got a trend.

By that measure, the talk about establishing new medical schools or medical school campuses in Canada definitely qualifies as a new trend.

The reason for all the chatter, I believe, is that we live in an era when Canada's relatively low number of medical school and residency spots have come under (Canada has more med schools than the US relative to the two countries' populations, but US schools are typically larger so the ratio of population to medical students in the two countries are similar) and the government of the day seems to be under constant pressure to train more physicians.

But when it comes to expensive, labour-intensive projects like establishing and running an entire medical school or even just a medical school satellite campus, the question always is: does the potential payout warrant the investment? In other words, do the following ideas for new Canadian medical schools hold water?

NORTH YORK, ONTARIO
York University's new president, the Egyptian engineer Mamdouh Shoukri, made waves not long after his appointment last year by announcing he wanted to start a medical school at York. "That is the future - to be a complete and comprehensive university. That is what my mandate is all about," he .

Tony Keller, writing on the Macleans OnCampus website last year, expressed : "If there’s going to be a new medical school in Ontario, the only logical place to put it is in the GTA, or close to it."

Considering York's proximity to the University of Toronto, the fact that its nascent is still very young, and that the Ontario government just spent a bunch of money starting another new medical school, the , it remained unclear for most of last year whether Dr Shoukri's proposal will get beyond the planning stages.

But despair not! Just last month, after Dr Shoukri at Toronto's Empire Club, the province's health minister, George Smitherman, , "When President Shoukri came to see me, I told him I thought the idea had merit but I wasn't going to be its champion. The more I've thought about it, the more I've become its champion; it's an innovative approach to training doctors rooted in the community."

The latest news is that York would mostly train family physicians to work on community-based health prevention and health promotion (though Dr Shoukri has said the goal is to ultimately develop a world-class medical and neuroscience research centre). In last fall, Dr Shoukri also mentioned the possibility of starting the school in a limited capacity, with a small mandate in the first several years only to certify the credentials of foreign-trained medical graduates, and then later to expand into a full-fledge medical school.

As time goes on, the chances of seeing a York University School of Medicine appear more and more likely.

COQUITLAM, BRITISH COLUMBIA
A local proposal to open a medical school campus in Coquitlam isn't nearly in as advanced a stage as the one at York. The sole mention of the idea recently was a quote from a city councillor : "Coun. Mae Reid, who chairs Coquitlam's Riverview committee, said the city's 50-year economic development plan envisions a medical school campus..." No further explanation, unfortunately. Coquitlam isn't far from Vancouver's downtown, so perhaps the idea is to open a satellite campus of the University of British Columbia's medical school? (Also: 50 years?! Some ambitious city planning, eh?)

GATINEAU, QUEBEC
A local lobby group is for a new French-language medical school satellite campus in Gatineau, across the river from Ottawa. announced at (PDF, French only) last month that it had recently proposed the idea to McGill and the University of Quebec. "They told me there is a great interest for the project," Dr Gilles Aubé, one of the local doctors pushing for the campus, told CBC News.

A petition supporting the proposal has collected over 40,000 signatures already. Proponents have cited two similar projects that were launched in the last few years -- in Trois-Rivières, with the University of Montreal, in 2004; and in Chicoutami, with the University of Sherbrooke, in 2006 -- and Health Minister Philippe Couillard sounds receptive to the idea.


Photo: , at the University of Northern British Columbia (medical campus affiliated with the University of British Columbia's Faculty of Medicine). This is probably the most interesting medical school campus in Canada, architecturally speaking.

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Tuesday, March 18, 2008

Grand Rounds 4.26 is up at Polite Dissent

This week's Grand Rounds collection of the best medical blogging was at Polite Dissent, a blog written by a family doctor named Scott and devoted to the seemingly disparate topics of medicine and comics.

Recommended reading from Grand Rounds: one nurse who when he has to give painful shots to kids, a new and type of CPR, and the state of Minnesota is considering that could irritate schoolkids' asthma.

Other recommended reading, not from Grand Rounds: Dr Trevor Hancock, the first leader of the Canadian Green Party, environmentally sound healthcare architecture in Canada as well as the UK.


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Monday, March 17, 2008

What's in the news and on the blogs?

The latest in Canadian medical news, and the best from Canada's physician bloggers.

IMMACULATE DECEPTION?
Dr Camil Vallières, a Quebec City family physician, is being sued for failing to tell a patient she was pregnant, . According to the statement of claim, the woman didn't discover she was pregnant until the seventh month -- too late for the abortion she would have chosen -- and had been drinking and smoking that entire time. The baby was born healthy. Prosecutors say damages amount to $750,000 in total.

DOUBLE-CLICK AND CALL ME IN THE MORNING
Manitoba's large internet pharmacy industry -- with 20 businesses operating out of the province -- is being threatened by the Manitoba Pharmaceutical Association, which recently introduced new rules that could withdraw licensing from internet pharmacies this summer, . The internet pharmacies' lobbyist has theorized that licenses may be unnecessary, anyways. "We haven't broken any rules, and we're pharmacies like any other pharmacy. If we follow the rules and we conduct our businesses appropriately, ethically and legally, I can't see how the pharmacy regulator could take our licences away," said Troy Harwood-Jones.

TESTING THE TESTS
The Royal College of Physicians and Surgeons of Canada and the Canadian Association of Pathologists are calling for a close look at how the nation's medical laboratory work is carried out. The Globe and Mail recent failures in lab testing in Newfoundland and Labrador and in New Brunswick have brought complaints about inconsistency and errors to the fore.

OUT OF IRAQ
The Toronto Star looks at the rise in the number of Iraqi doctors practising in Canada since the 2003, the year the US-UK invasion began. includes interviews with several doctors who moved here from Iraq over the past few years. "I came to the most comfortable, helpful, nicest people on this Earth. Oh my God, my patients, the nurses, the people, everywhere, amazing," Dr Mohammad Barbouti, a Newfoundland family doctor, said. "And you always think, why did it happen in Iraq? Why can't we be like this? Free, happy? Comfortable?"

HUMAN RIGHTS
Controversial Canadian journalist and free speech activist Mark Steyn, by the Ontario Human Rights Tribunal into the decision by Toronto plastic surgeon Robert Stubbs not to perform labiaplasty on two post-op transsexual women because he was not confident in his ability to perform the rarely requested procedure. Mr Steyn sees this Human Rights investigation as a farce, much as he sees all other such investigations across the country.

PREPARED FOR THE WORST?
Canadian provinces and territories have responded to the growing threat of healthcare-associated infections, like C difficile and MRSA, haphazardly and without sharing knowledge and best practices amongst agencies, as is made clear from the results of a survey conducted by the Public Health Agency of Canada's Infectious Diseases and Emergency Preparedness Branch, in tandem with a representative of the British Columbia Centre for Disease Control, in the Canada Communicable Disease Report.

DOCTORS' HELPERS
The University of Manitoba's training program for physician assistants -- the first non-military PA school in the country -- is . We wrote about Canadian flirtations with the idea of introducing physician assistants into mainstream practice .

MEDICINE 2.0
The is now available at ScienceRoll, including a mention of our new "" online book club.

MEDIA DOCTOR
The Tyee Alan Cassels, the man behind the health journalism analysis website .


And here's what our favourite Canuck doctor-bloggers are talking about these days:

"" -- "Today was the International Day of Protest Against the Canadian Seal Hunt. Today was also the “Celebrating the Seal” event here in Iqaluit." Husband and wife Dr J and Dr H, who write at Adventures in Medicine, went to a seal festival where one animal was eaten, raw, by the attendees.

Liberal MP and former physician Hedy Fry what she sees as the Harper government's return to the "dumbing down of Canada" by allowing "investments in science, technology and innovation [to] dry up" and because of the recent trend that has seen "evidence-based information, once the main rationale for good public policy... [give] way to vague, belief-based concepts."

The anonymous Montreal rheumatologist at Rheumination a new CMAJ study on gender bias by physicians.

Dr Couz, of Tales from the Emergency Room and Beyond, is .

The Healthy CEO, better known as Dr Larry Ohlhauser, : "At a recent corporate keynote,someone from the audience stated" attended your healthyceo seminar last year and you changed my life forever." I was pleased with the endorsement, but later thought, if my 3 hour seminar changed his life, what kind of life did he have before."

Dr Yoni Freedhoff, of Weighty Matters, bashes , , and . If you're a food item and you contain trans fats or misleading "health food" labelling, be warned: don't cross Dr Freedhoff.

This last one's not Canadian, but it's too interesting to go without mention here. Ever wonder what happens to all those bullets fired into the air in celebration? A Good Poop studies the .


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Thursday, March 13, 2008

Will the Alberta cabinet shuffle improve healthcare?

Nine days after the Alberta Tories captured yet another majority in the provincial election, Premier Ed Stelmach yesterday announced his .

One of the biggest changes is a portfolio swap between Dave Hancock, who was Minister of Health, and Ron Liepert (right), who was Minister of Education.

As was the case after the province's most famous trade -- the $15 million the Edmonton Oilers received in exchange for Wayne Gretzky -- what everyone wants to know is, who won? Will Mr Liepert be a better health minister than Mr Hancock was, or is healthcare getting short shrift?

DAVE HANCOCK
Mr Hancock wasn't wildly popular as health minister -- but, then again, he wasn't hated, either. There was of Mr Hancock potentially losing his seat in Edmonton-Whitemud this year, but the results ended up going strongly in his favour.

Two major infection-control scandals in Vegreville and Lloydminster may have hurt his cause as health minister. As well, the Alberta Medical Association (AMA) had with Mr Hancock over Bill 41, a piece of legislation passed in December that gave the government the authority to take control of professional regulatory bodies, including the College of Physicians and Surgeons of Alberta, in emergencies like those in Vegreville and Lloydminster. Nevertheless, the AMA said both before and after the election that it would be happy to continue working with Mr Hancock.

RON LIEPERT
Judging from Mr Liepert's Obama-like as health minister -- "Change has to take place" -- he's got big ideas. According to the Canadian Press, Mr Liepert will deliver an "action plan" for the province's healthcare system within the next month.

But really, it sounds like more of the same: "The current system is not working and it's not sustainable. It's obvious that more money hasn't produced a better product."

Based on the little that's been said so far, Mr Liepert is suggesting that the government control spending by implementing aspects of the 2002 , which include increased competition in the healthcare sector and alternative revenue models -- code words in most circles for increased privatization. that "he read the Mazankowski report this week and finds its recommendations are still as relevant today as they were when the report on reforming Alberta's health care system was released eight years ago." He also mentioned the 2002 (PDF), which suggested charging Albertans a health insurance deductible of up to 1.5% of their annual income.

Now, the Alberta Medical Association is pushing for a renewed focus from the government on improving access to physicians, by providing more resources for training and recruiting doctors, nurses and healthcare workers. AMA president Dr Darryl LaBuick told me earlier this week about his priorities for the next session of parliament. "Some of the big areas are, of course, first of all, improving our primary care networks, access to primary care, and recruiting an adequate amount of physicians to our province, in general practice and specialties, surgery, psychiatry, pediatrics. And a more stable electronic medical record environment in the province."

According to of Mr Liepert, opposition members are concerned about his style of governing.

"Part of what we're looking for in the health-care system is a need for predictability and the need for steady management and we've got a NASCAR driver, so hold on," said Laurie Blakeman, Liberal health critic.

"He's a NASCAR kind of guy, likes it fast and loud, fast and loose and puts his boots up on the desk and shoots from the lip."

Blakeman is skeptical about Liepert's knowledge in the health field, she said, since he doesn't answer questions or give meaningful input in the legislature.
Only time will tell whether healthcare will emerge the winner of this cabinet swap. But if Mr Liepert sticks to his word and moves forward and announces his plans as quickly as he has promised to, then we may know very soon whether this swap will benefit Albertans.

OTHER HEALTH NEWS
Also included in Mr Stelmach's announcement yesterday was the appointment of first-time MLA and former emergency physician as Mr Liepert's parliamentary assistant.

Dr David Swann, a Calgary Liberal MLA, with solid support. He's a fairly safe bet to continue on as the Liberal environment critic.


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Cutting-edge imaging brings medical science to life

The highlight the best scientific imaging from research around the world. Peer into the internal structure of an HIV particle, see how sperm develop in the testes or the life and death of prostate cancer cells (right).

Genome Alberta and Genome Canada launched a similar project earlier this month: a digital art contest with a prize of $1,000 for first place. Its bent is decidedly more aesthetic than scientific though, since organizers ask that submissions depict the "intersection of science and society."

Of the three entries so far, which you can vote for , one features a giant angel and another a giant turkey super imposed on a field of DNA entitled 'Getting Ready for Christmas.' Maybe each should come with an artist's statement to clarify these visions of science intersecting with society.

The field looks wide open and the deadline for submission is April 13. The winner will be announced at the in Calgary this April and may be featured here.

Photo: Colour-enhanced scanning electron micrograph by Dave McCarthy and Annie Cavanagh
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Wednesday, March 12, 2008

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Join our new medicine-themed book group!

has a new online book group called . Visit on the social networking site for book lovers, Shelfari, to check out our medical fiction and non-fiction library.

Why do doctors write?
Anton Chekhov, Arthur Conan Doyle, W Someset Maugham (right), William Carlos Williams were all medical men who sought and found fame and glory through their writing.

Today, Michael Crichton, Robin Cook, Vincent Lam (left) and Kevin Patterson carry on the tradition. Increasingly, medical men (doctor-writers are still primarily male) are turning to journalism, with writers like Jerome Groopman and Oliver Sacks dominating the pages of the New York Times and the New Yorker, feeding a new insatiable public interest in all things medical. And even more recently, doctors have taken to blogging - that most democratic of forums - as an outlet for their writerly urges.

Our new book group, , explores the question, "What makes doctors write?"

(For a backgrounder, check out and the ruminations on the topic.)

Our first discussion: Should doctors stick to what they know and write only about medicine? Join the discussion .

Here's a list of a few of the doctor writers we've profiled in the past in the :

: The former soldier, MD and novelist from British Columbia when he an article about a soldier's death in Afghanistan for an American magazine.

: The Toronto emerg doc hit the Can-Lit bigtime when his book, Bloodletting and Other Cures, . Margaret Atwood loved it.

: An encounter with sci-fi classic Day of the Triffids turned this aspiring MD into an aspiring sci-fi writer.

Surgeon-cum mountaineer-cum writer was mentored by the famous mountaineer Alfred Noyes and settled down in Whitehorse to write books about mountains.

Visit for more medical books we like.

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Canadian medical news update: Money, sex drugs, chilly Filipino nurses, gender bias and more

Here's a sampling of some of what we here at Canadian Medicine are talking about lately.

  • Some clinical trial participants in Prince Edward Island have been left out in the cold -- literally. Halifax dermatologist Barrie Ross tested a rheumatoid arthritis drug called anakinra to treat the rare disease familial cold autoinflammatory syndrome, a genetic disorder that causes patients to "feel like they're freezing from the inside out," . But now that the trial is over -- a big success, by the way -- the afflicted patients can't afford the $15,000-per-year medication. The government is "looking into the issue."
  • A recreational drug that had previously been mostly unknown is now becoming more popular in Canada, alluringly named "foxy methoxy." The appropriately named drug, a hallucinogen in the same family as magic mushrooms, is said to make one feel foxy -- or, , it "can draw its users into sexual temptation." Want to learn more? I've found two very different explanations of the drug for your perusal: one, a on foxy from the University of Maryland's Center for Substance Abuse Research (some more slang terms for the drug: "Trash, Dip foxy, Roxy, Yum Yum, Muffy, Excite-bike, Five9"); the other, several definitions of foxy methoxy (including a sample usage of the term that I defy anyone to explain to me: "Three schwags of fox to my nug grill! I blaze three foxes to my grill and nugged a dome past the schwag face!" Huh?)
  • Nine days of recruiting by Saskatchewan officials have netted the province 297 Filipino nurses. One concern for the recruiters was how to assuage the nurses' fears about the weather in Saskatchewan. "They shuddered at the temperatures but were excited," one official . "They thought the images of frost on the trees and the frozen river were beautiful." At a time when the brain drain and health human resources poaching are major concerns, the province wanted to ensure it was recruiting ethically, so a policy was developed to recruit no more than 10 nurses from any one hospital in the Philippines. ("When you're going into another country, it is imperative to act ethically and ensure you don't leave their system in chaos.") So spreading the brain drain more thinly is somehow more ethical than decimating just one or two hospitals? According to the Saskatchewan officials, their "consideration" was "much appreciated."
  • Do doctors prefer men to women? It seems so, at least when it comes to recommending knee replacement surgery, according to a in the Canadian Medical Association Journal. "Physicians are prone to the same automatic, unconscious and ubiquitous social stereotyping that affect all of our behaviour," write the team of Toronto researchers. How far we've come... Particularly notable about this study, besides its dispiriting results, is its unprecedented methodology. For the first time ever, researchers sent real osteoarthritis patients as part of "Operation Knee" to visit unsuspecting physicians to measure gender bias, instead of using actors, .
  • A woman whose 18kg tumour wasn't being treated quickly in Ontario decided to get treatment in Michigan, but the provincial government has refused to refund her $60,000 bill. "It's ludicrous," the woman . "Where's the judgment and the integrity in all of this?... I'm disappointed with the bureaucracy of it all."

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National Review of Medicine's March issue is now online

Dr Sanjay Gupta, CNN's resident doctor, graces the cover of our March issue, which is now . Dr Gupta, who's a brain surgeon in his spare time, about his thoughts on the US presidential candidates' health platforms, his near-death experience in Iraq, his opinion of Canadian medicare and the burning question: who's sexier, him or fellow CNN-er Anderson Cooper.

Also in this issue:
• Making sense of contradictory reports about
• Meet the . She talks about her hopes and gripes and why she sold the farm
• ? (What do you think? Take our Poll, on the right side of this page)

Click read more to see our full table of contents

National Review of Medicine, March 2008, Vol 5 No 3

FULL TABLE OF CONTENTS

PATIENTS AND PRACTICE

Inpatients die oftener than those in ED. Better training needed on wards


Too-low type II glucose kills. False, says rival trial


For women, urinary incontinence is underdiscussed and undertreated


Top-down infliximab beats step-up steroids, doubles remission rate


What to tell your patients


N-acetylcysteine beats other meds at fighting common scan side effect


Errors riddle 50% of death certs. Poor training blamed


New versions of old drugs fight rhinitis better


US doc’s program pays $1 a pound. Temporary fix, says Canadian expert


Open talk is key to allaying family fears, says MD. There is a middle way


Grassroots pain programs empower patients, ease family doctors’ burden

PRACTICE MANAGEMENT

New laws make apologizing to patients safe. What you need to know

POLICY AND POLITICS

Q&A with the American neurosurgeon and CNN correspondent


QC docs cheer Castonguay ideas, but gov’t wavers on bold reforms


Grit plans rife with half-baked schemes, charge analysts


Dr Anne Doig talks to NRM about her election win, her plans and her six kids


Mixed-pay clinics still short on data, many MDs remain wary

ADVANCES IN MEDICINE

Risks persist and longterm effects are unknown, warn experts


Montreal hospital latest to get $4 million assistant. Complications slashed


Sensitive device spots “twitchy” airways, easier on kids


Stick/non-stick, on/off gadgets are all about control

PHYSICIAN LIFE

Dr Gabor Maté’s new book is a gritty glimpse of Vancouver’s mean streets


An excerpt from Dr Gabor Maté’s new book


Chatham, Ontario, docs waltz their way to new MRI. “It was a highlight of my life”

PHYSICIAN WELLNESS

February is finally over. Did you get a day off?
PLUS NRM Quiz: How family-friendly are you, doctor? Take the quiz or click for a printer-friendly PDF version

PERSONAL FINANCE

Dealers slash stickers but costs still 20-30% higher than US

DEPARTMENTS
Castonguay throws Quebec docs a lifeline
Discord on ACCORD
Wait times impatience, doctors’ decision-making autonomy, the Chalk River crisis, and more
2008 federal budget forgets healthcare
Was Calgary MD-politician a Russian spy? Plus, more news from coast to coast to coast


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Tuesday, March 11, 2008

Grand Rounds 4:25

Welcome to Grand Rounds, the weekly anthology of the best writing from the medical blogs.


THIS WEEK'S TOP THREE

1 From Nurse Ratched's Place comes this week's most salacious post: "." Apparently a new survey conducted by Britain's Nursing Times found that one in 10 nurses think having sex with a patient is just fine, and one in six say they know a colleague who's done it. The controversy has been exacerbated by comments from Lord Mancroft, who called British nurses "grubby, drunken and promiscuous." But Nurse Ratched's Place author Mother Jones, RN isn't convinced: "... nurses are not sex crazed kittens looking for a hot date. We’re too old and tired to go to wild orgies after work. Sorry perverts. Start fantasizing about something else."

2 Training to become a doctor is akin to learning to sing opera, writes a Canadian med student in the Caribbean who , at Anatomy on the Beach.

3 We're willing to bet that husband and wife MD bloggers Dr J and Dr H, at Adventures in Medicine, are the northernmost physician bloggers in the world (check out the map to see where they are). They've made the bold claim that their hospital, in Iqaluit, Nunavut, has . The menu features such delicacies as arctic char fillets and caribou stew. But locals prefer the recently re-opened burger joint called The Snack: "LDL is up, HDL is down, but people are happy."


DOCTORS ON DOCTORS (or anyone else on doctors)

Dr Steven Palter, from docinthemachine, the six most commonly misinterpreted handwritten medical orders.

The UK's four-hour goal for emergency room admissions is a nice idea, writes Mousethinks, but it's resulted in some very creative . ER Nursey says American physicians with the same kinds of time limits, unfortunately.

MormonMD if med students are all addled on Adderall and then for 11 paragraphs about why he never has time to go see a doctor. "Getting the smallest of chores done can become a mammoth task in the face of an 80 hour work week," he writes. "However, the fact remains, the things I really want done, get done, seeing a doctor does not."

Dr Kishore Visvanathan, a urologist from Saskatoon, Saskatchewan, has to med students who do rotations with him.

Rita Schwab patient safety recommendations from Johns Hopkins researcher and physician Peter Pronovost, the man who's been pioneering the use of checklists in hospitals. (We wrote about his checklist project .)

A new study on sleep deprivation in MDs a bad case of the yawns. "I sleep less than anyone in my family or my friends. Is this a good thing? I don't know but it does allow me to indulge in blogging and reading and writing and yawn!!!! I'm tired."

Barbara Kivowitz at In sickness and in health a doc who seems to have skipped her patient-centred care seminar.

Patient-centred care? Poppycock, say the folks at who write: "Patients (and their care) ARE at the center of the health care system but at the same time we must recognize that patients are not paying the bills.... When patients pay the lions share of the bill they can and do have more say in their level of care."


MEDICAL SLANG

Before reading , all the term "Toxic" evoked for Canadian Medicine was our fave pre-meltdown Britney Spears . Now we know that, at least among Filipino doctors and nurses, it's a catch-all adjective that roughly translates to any hellish healthcare-related person or situation. Hmm, maybe the folks at LA's Cedars-Sinai Medical Center could relate.

Is medical slang GPO (good for parts only)? Check out our take .


JANE AUSTEN'S DEATH AND OTHER MEDICAL MYSTERIES

For more on the Jane Austen mystery, check out our post ""

"I understand Jane Austen had both trigeminal neuralgia as well as joint pain," .

"Has anyone suggested that Jane Austen might have had acute intermittent porphyria?" asks Dr Kenneth F Trofatter, of .

We were pleased by But You Don't Look Sick's of the Jane Austen biopic Becoming Jane which compared it unfavourably to the BBC's Pride and Prejudice. We agree (although we confess we do like James McAvoy as a stand-in for Colin Firth).

than Jane Austen, but we liked it: "A disabled man entered a hospital for care. He died. A multidisciplinary health care team may have hastened his death...that's sick. That's predatory. That's appalling. It's against the law. And it's wrong." Nuff said.


SEXING UP THE fMRI DOSSIER

Enough contributors wrote about fMRI that we had to give it its own section. We know, fMRI is very sexy. We don't think Canada can afford fMRI machines. Does this mean Canada's not sexy? Don't answer that.

The Samurai Radiologist's science side was turned on by that mapped brain differences in jazzers playing straight or improvised music. But the musician in him vows to "routinely deactivate major portions of my prefrontal cortex when I'm away from work, and let my instruments and my body move through the music on cerebellar cruise control alone."

Our psychiatrist friend at How to Cope with Pain is also , in her case a study in which chronic pain patients "watch their fMRI readout, then use coping techniques to modify the fMRI readout," she writes.

ScienceBase on why guys are bigger video game dorks than girls. Another fMRI study looked at male and female subjects while they played video games. Geek receptors in the guys' brains went totally nuts, apparently. (Canadians collectively ask: pretty please America, can we borrow your fMRI machines when you're done playing World of Warcraft?)

And speaking of video games, Dr Shock to an electric shock add-on for Xbox and other video games called Mindwire V5, which allows you to "feel the game" while you play. Subjects from V1-4 trials could not be reached for comment. If Mindwire needs testers, Canadian Medicine hereby volunteers its services.


OTHER POSTS WE LIKED

Canadian physician Dr R at My Med Jokes . "She said; 'Down below, the man has two holes and the woman has three holes. The baby comes out of that third hole. Any questions?' We looked at each other, feeling perplexed."

While we're on the subject, check out Hugh Laurie (in his pre-House days) and Stephen Fry's absurdist take on sex ed:


Vancouver's Dr Martina Scholtens, of FreshMD, recently recounted : "Me, to a patient who has just detailed his heroin addiction: 'How many alcoholic drinks do you have each day?' Patient, with disgust: 'I'm no boozer! I don't touch the stuff.'" In her free time, Dr Scholtens is an avid knitter; here's the list of her , including knitted brains (this one is by American physician Karen Norberg), a uterus and a digestive tract.

Removing a pyogenic granuloma from a patient's lip at an underequipped Guatemalan hospital is for Dr Paul Auerbach, a Stanford professor and wilderness medicine expert who blogs at Healthline's Medicine for the Outdoors. Be warned: gruesome photos ahead.

A heartbreaking story about treating Mr Schwartz, a former accountant who became homeless as a result of the medical costs associated with his late wife's breast cancer treatment, .

Nova Scotia-born Dr Val Jones retired Canadian Senator Michael Kirby (pictured left), one of the country's leading health policy experts, on her blog Dr Val and the Voice of Reason. This audio Q&A is a great introduction to how the Canadian healthcare system works, among other things. about his new role as head of the Canadian Mental Health Commission, his proposed booze tax and being an irresponsible grandfather.

Fever-autism connection? David Williams at Health Business Blog pediatric neurologist Michael Segal for his take on the recent autism-vaccine decision in the US: "Vaccines often trigger some fever, and fever can trigger episodes of many inherited metabolic diseases, so the link between vaccines and autism may be more than just coincidence."


THE NEXT GRAND ROUNDS

Thanks to everyone who submitted, either on one of our disparate themes or on any healthcare-related topic.

If you like what you see here at Canadian Medicine, please feel free to stick around and check out some of our other posts. You can subscribe to receive Canadian Medicine by email by entering your address here:



To find out who will be hosting Grand Rounds next week, check out the .

Update, March 12: Next week's Grand Rounds will be hosted by , an American doctor and comics aficionado.


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