Canadian Medicine

When it comes to apologizing, three provinces are already way ahead of Ontario -- but one legislator wants to change that.

Ontario Liberal MPP David Orazietti proposed new legislation on Tuesday to give the province its own version of the Apology Act. Similar laws are already in effect in BC, Saskatchewan and Manitoba, to permit doctors, nurses and others to apologize for adverse events and medical errors without incriminating themselves of malpractice in court.

"The Apology Act would enhance the dispute resolution process by allowing all Ontarians to communicate genuine compassion, sorrow and regret for a mistake without worrying that it could later be used against them in civil court," Mr Orazietti said in a announcing the legislation. "Other jurisdictions that have implemented this type of legislation have seen a reduction of pressure on their civil courts as well as reduced costs to public institutions, such as hospitals."

You can read the full text of Mr Orazietti's Bill 59 .

Bill 59 has already been endorsed by essentially all the major healthcare and legal groups in the province, including the Canadian Patient Safety Institute, the Ontario Medical Association, the College of Physicians and Surgeons of Ontario, the Ontario Bar Association, the Ontario Hospital Association, the Registered Nurses Association of Ontario and more.

There hasn't been any debate on the bill in the Ontario Legislative Assembly yet. In fact, Mr Orazietti's on Tuesday was abruptly cut short for some reason:

Mr. David Orazietti: I beg leave to introduce a bill entitled the Apology Act

The Speaker (Hon. Steve Peters): Is it the pleasure of the House that the motion carry? Carried.

First reading agreed to.

The Speaker (Hon. Steve Peters): The member for a short statement?

Mr. David Orazietti: The bill provides an apology made to or on behalf of a person in relation to any civil matter and does not constitute an admission of fault or liability by the person or an acknowledgement of liability in respect of a claim in relation to the matter, and does not affect the insurance coverage available to the person making the apology, and is not admissible in any civil proceeding.

Similar legislation has been passed in three Canadian provinces and 35 US states. The initiative is important as it would allow people to communicate compassion--

The Speaker (Hon. Steve Peters): Thank you.

Hopefully the provincial parliament will get a chance to review the legislation soon, although it sounds already as though the opposition parties may be open to the idea, according to Canadian Press article.

I wrote about Canadian apology legislation in last month's issue of the National Review of Medicine. Here's an overview of the current situation across the country, from :

Apology protection laws across Canada

British Columbia Canada's first Apology Act passed in April 2006 - but only after the law's sponsor found himself forced to apologize to opposition members of the legislature for calling their motion to delay a vote on the bill "sick," "reprehensible" and dishonourable.

Saskatchewan Apology protection was added to the Evidence Amendment Act in May 2007.

Manitoba Dr Jon Gerrard's Apology Act was passed in November 2007 and came into force last month after a 90-day waiting period.

Yukon Legislation proposed in April 2007 by Liberal MLA Don Inverarity hasn't yet been put to a vote. "I don't think it will see the light of day," he told NRM in a recent interview.

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Antidepressants . Or . Or . Or maybe -- just maybe -- they seem to have boggled the top minds in medicine and public policy and .

That's where University of Calgary psychiatrist and Heather Juby, a demographer from the government-run , come in. They're collaborating on , the first in a series of Research Data Centre Synthesis reports, to profile the current understanding of the epidemiology of clinical depression in Canada. (Download their full February 2008 report , as a PDF.)

The really interesting thing about their project -- besides their excellent research -- is the way they're trying to engage a broad spectrum of Canadians to discuss the report with them, in an interactive blog format.

The report's urges more Canadian investment in depression treatment. "The general message for policy makers is clear: investment in the prevention and treatment of major depression will be of enormous benefit to Canadians and the Canadian economy," it says. "The problem is substantial, and so must the investment be." Drs Patten and Juby also call for more specific research on some of the questions they feel haven't been answered to their satisfaction yet:

Focusing on “resilience” rather than “morbidity” would be a fruitful line for research into depression, as it has proved to be in other research areas, such as child outcomes. Identifying the characteristics and support networks of individuals who emerge relatively unscathed from stressful work, family or health situations could provide some useful insights into prevention of depression.

Equally valuable would be finding the answer to two of the questions raised by these studies: “Why do only half the people meeting the diagnostic criteria for depression seek professional help?” and “what factors contribute to the recovery of those who meet the diagnostic criteria for depression but who did not seek professional help?”

Those are some of the questions that the new blog Dr Patten has set up -- -- is intended to generate discussion on. In other words, as Dr Juby puts it in an introduction to the blog: "to encourage an exchange of information, ideas and questions between researchers, policy makers and others - about the synthesis, and about depression research more generally."

So far, Dr Patten has blogged about the reason some studies have shown spontaneous recovery among patients diagnosed with major depression and why that phenomenon has led some people to believe (erroneously) that antidepressants aren't effective, and the current debate in Canada about the link between SSRIs and suicide.

The blog hasn't sparked any discussion as of yet, but the idea itself puts Dr Patten on the cutting edge of health research communications. It's becoming increasingly apparent that one of the great, untapped powers of the internet in health research is to facilitate discussion amongst researchers from different disciplines. Dr Patten's blog, if physicians and researchers take him up on his offer to talk about depression, has a chance to become one of the first in Canada to truly achieve that goal.


Photo: Alberta Heritage Foundation for Medical Research

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The latest edition of Health Wonk Review, a biweekly health policy blog anthology, is at the blog.

Canadian Medicine makes a cameo with our recent entry on proposed legislation in Quebec that would legalize mixed public-private medical practices -- except that it's not likely to pass muster in the Assemblée nationale.

Of the many interesting posts in this week's Health Wonk Review, I recommend in particular:

• A by Joanne Kenen from the New Health Dialogue Blog on the Institute for Healthcare Improvement's recent 9th annual summit on Redesigning the Clinical Office Practice.

• Jason Shafrin of Healthcare Economist a study about the Hawthorne Effect as it pertains to physicians. "The Hawthorne Effect," write our Health Beat hosts, "is based on the idea that a given activity is performed better, in the short-term at least, when it’s observed by a third party." Mr Shafrin explains:

"In this study, doctors are observed by researchers. The study finds that objective measures of quality improve immediately after researchers arrive, but the quality improvement slowly decays over time until after about 10 observations, the doctor returns to their original quality level."

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, who holds the Canadian record for the amount of time spent space-walking, a research/clinical position at McMaster University after he retired his extraterrestrial job with the Canadian Space Agency and NASA last month.

"Dr Williams has had an extraordinary career, and he's been a great ambassador for Canada and for medical science -- both on and off the planet," the school's president, Peter George, announced recently. "His fearless dedication to finding new ways of bringing medical care to remote environments represents the most advanced edge of medicine under exploration these days."

He will now become the director of a new Centre for Medical Robotics at the McMaster-affiliated healthcare organization St Joseph's Healthcare Hamilton, focusing on technology that can be used to improve surgery practices both locally and remotely (called "telerobotic surgery"), in addition to appointments as a professor in the Department of Surgery and as an executive with St Joseph's.

We Dr Williams last November:

Is growing up to be an astronaut cooler than, say, growing up to be a ballerina? You know, my wife is a commercial pilot with Air Canada, she's the captain of A320s right now. She likes to say she has the best job in this world and I have the best job out of this world. I definitely agree with her.

Your fellow MDs in Canada are going through some tough times, particularly coping with physician shortages. Do you think it's inspiring for them to see you going into space, exploring this other frontier? I think it's inspiring, but I think it also helps challenge us to think about the way we look at earth medicine.

How so? Let's say I were to go to the moon as a physician. Do I have all the skills that I'd need to deliver healthcare as the only physician? And the answer is, I don't. The way we can do that is through telehealth. I think it's really exciting to look at how we can take these technologies we're working on in space and incorporate them into clinical practice on earth.

I hear a lot of astronauts develop kidney stones. How are your kidneys doing? Mine are great, as far as I know. One of the challenges when you're in space is the mobilization of calcium with the bone loss that we experience, which increases the risk of kidney stones.

Would you like to be the first Canadian on the moon? Love to — any chance of you funding the flight? [laughs] That's a dream of mine, actually. Not so much for me as for the next generation of Canadian astronauts. Right now NASA has a plan to send humans back to the moon. I think we can look forward to that happening before the 50th anniversary of Apollo, which is coming up in 2019.

One of your contributions to the space station potluck was caribou jerky. How did that go over with your fellow astronauts? They liked it. Jerky's a great thing to eat in space because there's not a lot of preparation required and the protein yield is very high. The Canasnacks [specially designed space cookies] were quite popular as well.

What's the first earthly pleasure you like to indulge when you get back on terra firma? For me, it's just being with my family and sharing the experience with them.

Your name is the Welsh form of David, Dafydd [pronounced Dahvith]. Are you a celeb in Wales? I don't know if I'd say I'm a celeb there, but they're certainly very proud of the fact that I've flown the Welsh flag in space. When I flew in space the first time, I had a chance to speak some Welsh from space with the BBC.

One of the astronauts in 2001: A Space Odyssey was also named Dave. Do your fellow astronauts ever rib you, saying stuff like "Good morning, Dave" in the voice of the movie's computer, HAL? [Laughs] Haven't had that happen yet. But I remember distinctly as a kid watching that movie and I think what's really fantastic is that a lot of the things we watched in movies and on TV as science fiction have become reality.

If NASA would let you do any zero-G medical research you wanted, what would you pick? Right now I'm very much involved in zero-G surgery and we've been doing a fair amount of work with laparascopic surgical procedures. The techniques you use are quite different than what you do on the ground with terrestrial surgery but it's the kind of thing we really need to start looking at if we're going to start sending people to Mars.

Any advice for fellow docs who might want to follow in your space steps? Right now, space medicine is a new, evolving discipline — I wouldn't say it's a speciality yet. People who want to get involved in that certainly have all kinds of opportunities, whether it's working in collaboration with the Canadian Space Agency or NASA.

What would you like your legacy to be? When I was sharing the idea of being an astronaut with folks I didn't get a whole lot of support. Most people told me it was impossible. I try to encourage kids to follow their dreams wherever that may take them and work hard with passion and persistence. That's the legacy I'd pick.

When are you going up again? Hard to know. I'm still quite young — I'm only 53. Right now I go to the back of the line, and it's a fairly long line, but I would certainly love to be able to fly in space again.

5 things you didn't know about... Dave Williams
Where he was when Neil Armstrong landed on the moon At home in Montreal watching it on TV. In those days they used to have space trading cards. For two cents you'd get five cards and a couple of sticks of bubble gum. I remember collecting those and watching totally enthralled as the original astronauts explored space.

His thoughts on space sex One of the challenges we face going down the road, particularly with these three year missions, is looking at how crews interact with one another.

His zero-G sweet dreams I actually prefer sleeping in space to sleeping on earth. In space, you don't have any pressure points and you don't need to worry about a pillow or anything because there's no gravity to resist against. You can close your eyes and literally fall asleep and just float around. It's really quite remarkable.

His extraterrestrial cuisine philosophy There's a cookbook called A Man, A Can, A Plan. That's pretty well what cooking's like in the shuttle or the station. You reach into your meal drawer and you pull out something and you warm it up.

Is there life out there? Biologically I think it's probable. One of the things that happens when you're on the space station and you look out into the heavens and you see the stars and galaxies that are out there, you can't help but reflect on the fact that we're just one very, very small planet in the midst of something that's absolutely infinite.

Interview conducted by Gillian Woodford

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Alberta's new health minister, Ron Liepert (right), today released the that he's been hinting at for the last month, trying to get the public and the media excited for a major overhaul of the province's healthcare system. "Change has to take place," he declared upon taking office. But the plan released today doesn't live up to the hype, say critics.

A from the Edmonton Journal sums up Mr Liepert's plans as follows:

- A provincial patient portal that will allow Albertans to look at their health information online.
- A new governance model for regional health authorities that may see a change in the number of health regions in the province.
- A pharmaceutical strategy that could include a plan to buy drugs in bulk, keeping costs down.
- More beds for people with mental illnesses or addictions.

Other initiatives in the plan include "mandatory accreditation and reporting for all Alberta health service providers and facilities," infection prevention standards, more training and recruiting of healthcare professionals, and a "patient navigator system to improve access to health services and continuity of care."

Mr Liepert that his plan includes no move towards further healthcare privatization. "There's nothing here that I am aware of that should cause any concern to Albertans or Canadians relative to the Canada Health Act."

As is the case with many such sweeping healthcare reform plans, the specifics are lacking. The new action plan amounts to a set of plans to create action plans in the future, essentially. The Canadian Press :

Dave Taylor, health critic for the Opposition Alberta Liberals, said Wednesday the patient navigator concept is a good idea, but Liepert's overall plan is short on specifics, especially on privatization.

"I'm waiting for the other shoe to drop before I say whether this is a good idea or not," said Taylor.

NDP Leader Brian Mason said the announcement is a fuzzy promise for change that lacks clear benchmarks and he'd like to see a plan that sets out clear goals.

The Edmonton Journal kindly recorded today's seven-minute announcement by Mr Liepert. You can listen to it or by clicking play below:



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Injection drug users who leave the city of Vancouver fare better than those who stay, according to to be published this September in the journal Health & Place by some of Canada's top addiction researchers.

A team of UBC and Simon Fraser researchers, including prominent HIV and addiction researchers Evan Wood and Thomas Kerr, report that emigration out of Vancouver is associated with less frequent crack smoking; less heroin injecting; less involvement in prostitution; fewer overdoses; fewer instances of incarceration; lower risk of contracting HIV; and better housing. However, leaving the city was also associated with higher rates of alcohol abuse -- a way to "cope with the stresses of migrating or the reduced availability of harder drugs outside of Greater Vancouver," the researchers theorize. Also, leaving Vancouver meant decreased use of methadone, either from less access in rural areas or from a decision to attempt to avoid all contact with drugs.

While social conservatives blame drug addiction's dangers on liberal culture's moral decay, and progressives place the blame on insufficient treatment, it seems that Vancouver itself is toxic. Perhaps the best advice physicians in Vancouver can give their drug-addicted patients is: get out of here.

MORE INFO
Further reading on this subject from the National Review of Medicine:

• An by Drs Wood and Kerr and others on the government's anti-drug strategy
• A of Vancouver addiction physician Gabor Maté
• An from Dr Maté's recent nonfiction book, In the Realm of Hungry Ghosts

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A new article from the University of Ottawa presents a unique take -- from a mathematical perspective -- on the controversial human papillomavirus (HPV) vaccination programs that have arisen in various Canadian provinces over the last year or so.

Whereas past criticisms of the immunization programs, which offer free voluntary vaccinations to pre-teen girls in Canadian schools, have focused on clinical and ethical concerns about the initiative*, the mathematical critique takes the opposite position: expand the vaccine campaigns beyond their current scope.

In their April 10 article in the journal BMC Public Health, mathematicians Marco Llamazares and (yes, Robert Smith?'s name really includes the question mark) show that to successfully eradicate the targeted HPV strains, free vaccination should be extended to some adult women as well.

From this graph in their paper, which is (PDF), you can see that the effect of vaccinating some adults has a huge effect on the potential for disease eradication:At current rates of acceptance for ongoing children's HPV vaccine campaigns in Canada -- around 50-60%, at a rough estimate, based on some -- the Llamazares/Smith? model says approximately half of women up to the age of 26 would need to receive the vaccine in order to achieve disease eradication. If rates of vaccination climb among children to, let's say, 75-80%, then very few or zero adults need to be vaccinated in order to rid ourselves of the targeted HPV strains.

"[T]he level of adult vaccination coverage required is modest and may be achieved simply by removing the cost burden to vaccination," write Llamazares and Smith?. Their solution? "We recommend that provincial healthcare programs should pay for voluntary adult vaccination for women aged 14-26."


*You can read about some of those criticism in recent articles in the National Review of Medicine: "" [opinion], "" and "."

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Despite the fact the provincial government failed to allocate any new money to York University for its recent proposal to open a new medical school, the school is moving ahead.

Today, Dr Peter Walker (right), the former dean of medicine at the University of Ottawa, as the man entrusted to get the ball rolling on the new York school of medicine.

"Dr. Walker is an internationally respected expert on medical education. He shares our vision of a medical school that will build on York’s strengths of interdisciplinary education, innovation, global reach and social commitment," said [York University President Mamdouh Shoukri]. “His combined academic and medical experience make him an ideal architect to build a plan that could lead to a viable medical school model."

The York University Academic Plan 2005-2010 calls for the development of a medical school proposal. Walker will play a lead role in turning the vision articulated in the University’s Academic Plan into the reality of a proposed plan. He brings to the task his experience as a medical educator, as former Dean of the University of Ottawa Faculty of Medicine and his current participation in the University of Ottawa's Academy for Innovation in Medical Education.

As Special Advisor on Medical Education, Office of the President, Walker ultimately will propose a viable plan for a medical school which will be a major contribution towards meeting the ever growing health care needs of our expanding and diverse communities. Walker will be working for York University on a consulting basis while continuing as a member of the Faculty of Medicine at the University of Ottawa.

"I look forward to working with Dr Shoukri and his colleagues to help advance the case for an innovative medical school at York University," said Walker. "I am excited by the possibilities that this opportunity offers."

Walker earned his doctor of medicine (MD) degree in 1972 from the University of Ottawa. He also holds degrees in both internal medicine (FRCPC) and endocrinology (CSPQ). In addition to teaching medicine at the University of Ottawa, Walker has held a range of professional positions including Head of the Department of Medicine at the Ottawa Civic Hospital and Chair of the Council of Faculties of Medicine (COFM) of Ontario. Walker also recently led a technical working group for scaling up health worker education and training in developing countries; this project was sponsored by the World Health Organization.

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While conservationist Paul Watson has of late become a household name in Canada, less well known is that among the anti-sealing crew of the Farley Mowat, the ship owned by Mr Watson and seized by the RCMP Saturday off the coast of the Nova Scotia, is Dr Merryn Redenbach (right), an Australian pediatrician from a suburb of Melbourne.

Dr Redenbach, the ship's physician, was detained by Canadian police in Sydney, Nova Scotia, along with the rest of the crew after the RCMP boarded their ship and forced them off it at gunpoint, accusing the Farley Mowat of violating Canadian law by coming too close to the seal hunt without a permit. The captain and first officer have been arrested and , while the rest of the crew have been released. Mr Watson posted $10,000 bail for the two arrested sailors, half of it in toonies, with money from the real Farley Mowat, the Canadian author and conservationist for whom the ship is named. (For a chronology of events, see The Globe and Mail's .)

Dr Redenbach and others are now to protest their fellow sailors' arrests.

The crew were arrested at gunpoint in a location they claim is in international waters, outside Canadian jurisdiction.

In an interview with The Australian published today, Dr Redenbach :

Dr Redenbach said she was leaving a room and about to enter a hallway when a Royal Canadian Mounted Police tactical response unit descended on the ship armed with automatic rifles and sub-machine guns.

"They entered our ship, which is an unarmed conservation vessel, and arrested ... all of the crew," Dr Redenbach, a pediatrician at Melbourne's Royal Children's Hospital, said from Sydney, Nova Scotia today.

"It was quite frightening because I was in a room and needed to step out into the hallway and I didn't know how they would react to that.

"At that time I was made to ... lie on the floor, with my hands on the floor, as were all of the other crew members."

The crew lay there for about 10 minutes before they were moved to the bridge of the ship.

They were held on the ship's back deck for about two hours before they were arrested and charged under Canada's Marine Mammals Regulations, Dr Redenbach said.

She said she was terrified, and worried about how the armed officers would react.

"They had guns which were pointed at us.

"It's a frightening experience to have an automatic weapon pointed in your direction.

"I was hoping that the people who were arresting us were professional and would not be easily alarmed into acting violently."

Dr Redenbach said the crew was transferred to a coast guard vessel in a metal box attached to a crane.

Female crew members were handcuffed to rails inside the vessel while the men were kept on the deck in zero temperatures for four to five hours, she said.

Think what you will about the seal hunt, but it's becoming difficult to condone the Canadian response, which now seems overzealous. Allegations have been made repeatedly -- not just in this incident -- that the Farley Mowat has attempted to damage whaling and sealing ships (and sometimes has done so successfully), but it remains unclear that that is in fact what happened near Nova Scotia last week.

And whether or not you side with the government or the protesters, it's hard not to admire the strength of Dr Redenbach's convictions. According to a on the Sea Shepherd Conservation Society website (the organization run by Paul Watson that operates the Farley Mowat), seeing video footage of the seal hunt inspired her to take a year off from her pediatrics work to join the protest.

"Working with tiny premature babies and people with severe cognitive problems has taught me that the ability to suffer pain and distress aren't dependent on an IQ score. Inflicting pain on the helpless - whether humans or non-human animals - is a terrible thing and we should all stand up against it."

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March 30 came and went in Canada with nary a whisper of the admirable American decision to mark that day as National Doctors' Day, to recognize the efforts of the physician workforce.

"National Doctor's Day is an opportunity to recognize these physicians - the ones who have helped us when we were sick, the ones who have delivered our children, and the ones who have helped us remain healthy through immunizations, screenings and other means," Dr Ronald M Davis, the president of the American Medical Association, on March 30.

Now, I'm typically the last person to advocate for yet another greeting-card holiday, but doesn't National Doctors' Day seem like a good idea? So why hasn't Canada caught on? I'm not sure; it would be quite easy. In the United States, the day was designated as such by legislation in both houses of Congress in 1990. With a bunch of active and energetic physicians in our Parliament here, why shouldn't we expect the government to establish a National Doctors' Day? I even have a suggestion of what day it should fall on in Canada: July 12, the birthday of our most celebrated physician, Sir William Osler.

2008 may have come and gone already with no National Doctors' Day, but hope is not lost, fellow Canadians! The Upper Ottawa Valley Medical Recruitment Committee, though admittedly not a hotbed of national physician organization, nevertheless appears to have this year become the first group of Canadians on March 30.

"We are fortunate to have an outstanding group of skilled and dedicated physicians and other healthcare professionals available to serve the inpatient, outpatient and specialty needs of our community," Debbie Robinson, the chairwoman of the committee, told The Daily Observer, "and by choice or by chance, each of us may find that because of a caring physician, our lives have been profoundly improved.

"Doctors' Day serves as a reminder to all of us to be thankful for the care we've received and to thank our doctors for all that they do."

Now the rest of the country has only to follow their example.

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When I , the experimental safe-injection site in Vancouver, a Health Canada spokesperson told me the government was still unsure of the facility's benefits.

Health Canada continues to repeat that more research is needed on Insite to determine how safe-injection sites affect crime, prevention and treatment.

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research [federal Health Minister Tony] Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, "To see if Insite is getting people to programs to help them get off drugs."

Well, the verdict is in: improves drug addicts' access to treatment and counselling, doesn't increase crime, and although the question of prevention still remains unanswered, it shows an overall "positive cost/benefit ratio." That's according to released Friday by the Expert Advisory Committee drafted by Health Canada to look at the effect of safe-injection sites.

The Health Canada panel's report came to seventeen conclusions, as follows:

1. Over 8,000 people have visited Insite to inject drugs. 18 per cent account for 86 per cent of the visits, and less than 10 per cent used Insite for all injections.
2. The average user has been injecting for 15 years; 51 per cent inject heroin and 32 per cent, cocaine.
3. The injections at Insite account for less than 5 per cent of injections in the Downtown Eastside.
4. Insite provides a clean environment for drug use.
5. Insite provides nursing services to a large number of users.
6. The general public has positive views of Insite.
7. Users rate the service as highly satisfactory.
8. Insite encourages users to seek counselling and treatment, which has resulted in an increase in treatment engagement.
9. Insite facilitated vaccination during an outbreak of pneumonia in 2006.
10. Mathematical modelling shows that Insite saves about one death by drug overdose each year.
11. The assumptions that researchers make about HIV prevention may not be entirely valid and are therefore inconclusive.
12. Between 6 weeks before and 12 weeks after Insite opened in 2003, there were reduced numbers of users injecting in public.
13. There is no evidence of increased loitering, dealing or petty crime in the area around Insite.
14. Analysis of police data shows no change in the crime rate in the Downtown Eastside.
15. There is no evidence that SISs influence rates of drug use in the community or increase relapse rates among injection drug users.
16. Insite costs $3 million per year to operate, or $14 per user visit.
17. Insite shows a positive cost/benefit ratio (with cautions as to the validity of the mathematical model used).

If the federal government is looking for an excuse to kill the Insite experiment, which only has two and a half months left on its current exemption from federal narcotics laws, then the panel's inability to find that the facility improves prevention of drug addiction may prove fatal.

But I'd like to suggest that perhaps given the unimproved poverty in Vancouver's Downtown Eastside, where Insite is located, it should come as no surprise that prevention hasn't improved. Perhaps the prevention of further harm and more death should be prevention enough, and we shouldn't expect one single intervention to solve the problem of drug addiction itself. After all, this is a "harm reduction" project we are talking about -- not harm prevention. (Insite itself recognizes this concept: its goals include access to health, harm reduction and improved public order, but not prevention of drug addiction.)

Given the panel's 17 conclusions, BC chief medical health officer Perry Kendall , if the government fails to grant an extension to Insite's licence to operate, "you might have to think that it's ideological or political."

But that's not entirely out of the question, of course, as I wrote last year of the current federal government's agenda:

Stephen Harper's attitude about how society should treat drug addicts was outlined in a 2003 essay he wrote about the Left called "Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral neutrality on the use of marijuana or harder drugs mixed with its random moral crusades on tobacco. It explains the lack of moral censure on personal foibles of all kinds, extenuating even criminal behaviour with moral outrage at bourgeois society, which is then tangentially blamed for deviant behaviour."

In the meantime, before the Insite licence expires on June 30, two lawsuits are headed to the British Columbia Supreme Court, arguing firstly that the federal government has no jurisdiction over a provincially funded healthcare facility and secondly that canceling Insite would violate users' constitutionally guaranteed "security of the person."


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