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Showing newest 18 of 32 posts from September 2008. Show older posts
Showing newest 18 of 32 posts from September 2008. Show older posts

Tuesday, September 30, 2008

Unique Quebecers serve as research population for DTC pharma ad study

Residents of Quebec have unwittingly become the subjects of a recent medical-research experiment conducted by a team of international researchers. If your thoughts suddenly turned to the CIA/MKULTRA with LSD and brainwashing at McGill, don't worry: this year's experiment is nothing so nefarious.

In a , published online September 2 in the British Medical Journal, a team of Harvard and University of Alberta researchers studying direct-to-consumer advertising (DTC) realized that Quebec is the ideal place to compare the effects of DTC advertising on drug sales.

Why Quebec? The English-French divide -- Hugh MacLennan's two solitudes -- represents a unique situation. The entire population of Quebec lives in very close proximity to the United States, where DTC drug advertising is legal, but a portion of the population (the anglophones) are much more likely to see those ads than the other portion (the francophones) who would tend to stick to French-language and therefore Canadian television channels, radio stations and magazines produced in Canada, where DTC ads are illegal.

Harvard Medical School's Michael Law, the lead author, explained in :

“It’s not an absolutely perfect control group... There’s obviously a small percentage of Quebec residents who are exposed to English language media. But as control groups go for this sort of observational study, it’s about as good as you get."
The researchers chose three drugs to look at: etanercept, mometasone and tegaserod. They compared sales among anglophone Quebecers to sales among francophone Quebecers, both before DTC ads began and after they started.

The results are rather surprising: the only significant difference between the two populations' sales were for tegaserod, but even that drug's sales eventually leveled out.

The conclusion to draw from this research -- though it contradicts what seemed before like common wisdom -- is that DTC advertising doesn't really work very well.

The BMJ study comes at a time when DTC advertising is a hot topic in Canada.

Canadian research has shown that introducing DTC advertising increases government health spending on pharmaceuticals; , which did an admirable job comparing the notoriously difficult-to-compare American and Canadian situations, was published last year by a respected University of British Columbia epidemiologist, Steven Morgan, in the journal Open Medicine.

CanWest, the owner of dozens of newspapers and televison channels across the country, filed a lawsuit in 2005 challenging the Canadian government's ban on DTC advertising. Their lawsuit, which is being dealt with in Ontario Superior Court, has not reached trial yet.

A separate CanWest lawsuit, filed in federal court against the Minister of Health and the Attorney General, claimed that the Canadian government was obliged to enforce its ban on DTC advertising even in American magazines that could be purchased in Canada. That suit was in July 2007. CanWest appealed, but in the Federal Court of Appeals refused to reverse the lower court's decision. (CanWest has not yet commented on whether they will attempted to appeal that decision further; check back here for Canadian Medicine follow-up in the next few days with CanWest's response.)

The Canadian Health Coalition, which is staunchly opposed to the introduction of DTC advertising in Canada, has put together a good-sized -- albeit selective -- collection of articles and resources on the topic , including the text of affidavits filed in the CanWest challenge in Ontario.

Photo: Shutterstock


What's in the news: September 30 -- Tony Clement, MD politicians, Sarah Palin sympathy, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 30.

Winnipeg's Health Sciences Centre hospital, where a homeless man died of a bladder infection last week after waiting in the emergency room for 34 hours, has implemented changes to prevent another, similar tragedy. [] Although it's not entirely clear yet why the man was not given the care he needed, the hospital plans to add staff and has come up with a colored wristband plan to keep track of patients who have yet to be triaged. []

A short Globe and Mail profile paints a picture of Tony Clement's reelection campaign -- he won a seat in Parliament in 2006 by just 28 votes -- as being nearly a lock this time around. []

The Canadian Medical Association counts 12 physicians running in this year's federal election: seven for the Liberals, three for the Greens, and one each for the Tories and NDP. [] Profiles and links to the websites of each are available on the CMA's election page. [] At first glance, the four incumbents -- all Liberals -- seem safe in their ridings; the rest of the physicians all face difficult races.

Newfoundland nurses are refusing to do cleaning, stocking and clerical work to pressure the government in negotiations. []

New accusations arise about the sudden resignation earlier this year of Alberta's top public health staff. Alberta NDP leader Brian Mason says the doctors' departure was due to a disagreement with the government over how to alert the public to a syphilis problem. [] Health Minister Ron Liepert already took some flak for his work on the syphilis awareness campaign in August, which we wrote about .

Meanwhile, just yesterday, Mr Liepert announced changes to the chief public health officer's role. He also clarified the relationship between the Ministry of Health and the new Alberta Health Services board. []

Several Ontario physicians are planning on opening a medical-tourism surgical clinic to cater to Americans and other foreigners. []

Ontario's auditor-general blames poor hand hygiene and infection-control practices for the recent outbreak of C difficile in the province's hospitals. [] I can't help but wonder: Didn't we already know that?

Edmonton obesity specialist Dr Arya Sharma is anti-marathon. []

Dr Martina Scholtens, having watched Sarah Palin squirm as foreign leaders ogled her, writes about how she deals with inappropriate sexual comments from patients. []

Two York University researchers are editors of a new book published by Canadian Scholars' Press Inc, called Women's Health: Intersections of Policy, Research, and Practice. []

Grand Rounds is available at Monash Med Student. Be warned: the author is a former tank commander, and the post is filled with rather explicit photos of war. []

Beware of the "sumo virus," or "scrumpox." []


Monday, September 29, 2008

The doctor's lounge is going the way of the dinosaur

By Christina Schallenberg, Clinical Editor, Parkhurst Exchange
Exclusive to Canadian Medicine

The Canadian doctor's lounge is on the road to extinction.

These days, when hospitals go through renovations, the doctor's lounge is often one of the first things on the chopping block. "It's no longer a priority," laments Dr Louise Nasmith, co-chair of the Collaborative Action Committee on Intra-professionalism (CACI), which works to improve collaboration between physicians. A similar complaint comes from Dr Preston Smith, head and academic leader of the Maritime Network of Family Medicine at Dalhousie University: "The doctor's lounge is disappearing in a lot of places," he says, citing a number of reasons, including space considerations and hospital authorities' failure to appreciate the benefits of the lounge. "The main value of the doctor's lounge," says Dr Smith, "is the promotion of intra-professional collegiality."

As doctor's lounges vanish, physicians aren't the only ones who will suffer: aside from good old socializing, lounge conversations have been known to speed up many a case. "I certainly have witnessed it in my career that a patient was on a wait list for six months, and after a conversation in the doctor's lounge the specialist said, 'I'll do that tomorrow,'" recounts Dr Smith.

Then there's the aspect of continuing medical education that takes place and, finally, the efficiency of face-to-face communication that allows for shortcuts. But as doctor's lounges dwindle in numbers, this kind of collegiality is bound to take a beating.

There still is a lounge at the Moncton, New Brunswick, hospital where Dr Smith practises once a week, and he believes that patient care -- and possibly even cost effectiveness -- are the better for it. A chat in the lounge is a great opportunity to be your patients' advocate without having to deal with faxes, emails or secretaries. It streamlines communication and promotes social interaction.

Without the lounge, physicians are more prone to working in isolation, without knowing the faces, names or specialties of some of their colleagues -- even if they're treating the same patients. Such simple "deficiencies" are among the major factors hampering an informal information exchange between physicians, according to the University of Toronto-based authors of the (SCRIPT) study, published last year in the Journal of Interprofessional Care. As a result, collaboration suffers.

Dr Nasmith's Collaborative Action Committee on Intra-professionalism, established in 2007, was formed to address intra-professional issues such as the communication between doctors. It may not be a coincidence that such a group was deemed necessary at a time when the doctor's lounge has all but disappeared. And even in places where the lounge still exists, its character has changed.

Twenty-five years ago, the doctor's lounge was frequented regularly by two-thirds of the physicians at his Moncton hospital, Dr Smith recalls. But it's a different story today: "They're skipping coffee, skipping lunch, working right through the day," he says. Thanks to an exploding workload, there simply isn't time to hang out and have a coffee break with your colleagues.

Younger doctors, more so than older ones, seem to avoid the lounge, Dr Smith observes. They may be worried that if they show their faces, a colleague will seize the opportunity to put even more work on their plates. With doctor's lounges vanishing across the country, it's also possible they've never seen one from the inside during their training, so they may not know what they're missing.

Doctor's lounges are disappearing from hospitals, yes -- but, this being the always-plugged-in 21st century, virtual doctor's lounges are ascendant. Social-networking has taken off on the internet, and the medical community has taken note: , a Canadian Medical Association website, and , a private American firm, among other sites, offer doctors the opportunity to communicate with one another online, without having to worry about patients listening in. The content of the websites is similar to what you find in a real doctor's lounge: clinical queries, jokes, complaints and even a little bit of flirting.

The internet, however, doesn't make a good doctor's lounge -- a real-world one -- redundant. Dr Smith counts off some of the features that he appreciates in Moncton: a central location and comfortable seats, access to electronic health records to facilitate discussions about specific cases and -- last but not least -- good coffee.

So would he protest if his lounge were to close? "Definitely. And I wouldn't be alone."

Photo: Shutterstock


What's in the news: September 29 -- Dr Garlic, Réjean Thomas, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 29.

A Victoria, BC, lawyer is attempting a defence of a man arrested for heroin possession based on the claim that because the government failed to provide a safe-injection site for him to use, his right to life and security of the person under the Charter of Rights and Freedoms were violated. The man has pleaded not guilty. []

Widely reviled South African Health Minister Manto Tshabalala-Msimang, a former obstetrician-gynecologist and public health expert who promoted natural products to fight AIDS -- like garlic, lemon and beetroot -- instead of antiretroviral drugs, has been removed from the health portfolio, causing AIDS activists the world over to rejoice. [] The move is a result of the recent political upheaval in South Africa that has seen President Thabo Mbeki, who denied that HIV caused AIDS, leave office. Dr Tshabalala-Msimang famously banned Stephen Lewis, the former UN Special Envoy on AIDS in Africa and Canadian ambassador to the UN, from the country after he delivered a scathing speech about her policies in Toronto at the 2006 International AIDS Conference.

Vancouver police explained why it was necessary to use a Taser to subdue and arrest a 16-year-old mother who was holding her baby in her arms at the time of the shock. Social workers said that the baby, who was ill, might be smothered. []

The UK will follow Canada's example by putting disturbing photos on cigarette packages to discourage smokers. []

The Goudge Commission's report will be released on Wednesday at noon, and The Globe and Mail's Kirk Makin has the inside word on what measures the inquiry, set up to investigate the entire field of pediatric forensic pathology in Ontario in response to the numerous wrongful convictions made using the flawed testimonies of Dr Charles Smith, is likely to recommend. []

Ron Liepert, Alberta's health minister, faces criticism for not disclosing the preliminary report by a consulting firm hired to study the province's healthcare system. []

In other Alberta news: Mr Liepert has expressed his displeasure with the Calgary Catholic School District's decision not to offer the HPV vaccine to students. []

Dr Réjean Thomas, a Montreal doctor famous in Quebec for his work with HIV/AIDS patients, is the subject of a new biography/as-told-to autobiography by journalist Luc Boulanger, titled Réjean Thomas, médecin de couer, homme d'action. The book's preface is written by Dr Thomas's friend, ex-Parti Québécois leader André Boisclair. [] [] [] [buy it ]

Wayne Christian, the co-chair of the Shuswap Nation Tribal Council, in BC, wrote a very eloquent article in last week's edition of The Lancet about the medical, psychological and social consequences of Canada's residential schools system. He acknowledges the government's recent apology, but sharply criticizes Canada's decision to vote against the UN Declaration on the Rights of Indigenous People in 2006. [ (subscription required)]

Minnesota legislators are headed to Ontario and Manitoba to study the Canadian healthcare system. []


Friday, September 26, 2008

What's in the news: September 26 -- Public reporting, Canadian drugs in Boston and Rwanda, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 26.

Ontario will finally follow Quebec's lead by today starting to publicly report its hospitals' Clostridium difficile infection rates. The data will be available after 1:00pm today at . By April 2009, seven other items will be included in the public reporting: MRSA, VRE, Hospital Standardized Mortality Ratio, central line infections, ventilator-associated pneumonia, postsurgical infection prevention, and hand hygiene compliance. []

A program run by the City of Boston to provide workers with Canadian prescription drugs has been terminated by the Winnipeg pharmacy that had been supplying the medicines because of an apparent lack of interest. One city council member, however, theorizes that the federal Food and Drug Administration pressured Boston to drop the program. [] Recent news about counterfeit drugs produced overseas (remember the tainted heparin from China?) could have contributed to the low enrollment in the Canadian drug program, the Wall Street Journal's Health Blog.

André Picard bemoans (as we all have done at least once or twice before) the shortcomings of Canada's Access to Medicines Regime, the law designed to provide the framework for generic drug companies to produce HIV medications to be sent to Africa. On Wednesday, the first shipment of drugs went out after four years of endless red tape. Mr Picard says that one shipment, however, may be the last. "[T]his tragic reality should fill us with shame," he writes. []

Former Member of Parliament Belinda Stronach and former British Prime Minister Tony Blair coauthored an op/ed in yesterday's Globe and Mail calling for more funding worldwide to prevent the spread of malaria in Africa. []

Dr Michelle Greiver gives an excellent analysis of the current situation for physicians buying electronic medical records (EMR) software in Ontario. []

A law enacted in Nebraska in July making hospitals "safe havens" for parents to abandon children without legal fears has encountered an unintended consequence. The law failed to specify an upper limit on the age of the children that could be abandoned; other states typically only apply the safe-haven law to infants under 1. On Wednesday, a 34-year-old father left 9 of his 10 children at Creighton University Medical Centre -- the youngest was just 20 months, the oldest a 17-year-old. [] And in the last two weeks, reports USA Today, three children aged 11 to 15 were left at other hospitals. "We really opened a can of worms," Arnie Stuthman, the state senator who wrote the law, told USA Today. "We have a mess."[] []


Thursday, September 25, 2008

What's in the news: September 25 -- Leaky pipes, a new BC med school, and envious MDs

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 25.

A ventilation leak of potentially fatal glycol fumes at a Saint John, New Brunswick, hospital forced a partial evacuation yesterday. One OR is closed today, but otherwise the hospital is back up and running as normal. []

The recent threat of a NAFTA challenge to Canadian public-healthcare protection rules might be just what some Canadian politicians (read: Gordon Campbell, Jean Charest, and ohers) have been hoping for, Canadian Doctors for Medicare member Dr Randall F White surmises in a new essay.
[] Besides what seems like a patently unfair dig at the man behind the free-trade threat, Melvin Howard, for allegedly being bipolar (unless I am misunderstanding him), Dr White's essay is a very smart piece of writing on the subject.

A British Columbia government health official wants to see a second medical school in the province, perhaps at Simon Fraser University. [] There was some talk in Coquitlam about a satellite campus of UBC's medical school a while back, which I wrote about in my article ""

With Canada's healthcare system apparently entering a period of flux, the Royal College of Physicians and Surgeons of Canada is concerned about protecting medical education. []

Advice on how health professionals can avoid having an envious workplace: hire well, cooperate, encourage cooperation, communicate, and pair up mentors and trainees. []


Wednesday, September 24, 2008

Suicide watch: The internet's deadly influence

I recently became aware of a very disturbing fact about this blog.

Looking at Canadian Medicine's traffic numbers not long ago, I noticed that the tenth most popular article on the site in terms of the number of pageviews is my short October 12, 2007 entry "," which was a summary of and reference to a very good piece in The New Scientist. It's nearly a year old now, and not something I would have guessed would be of particular interest to many readers seeing as it's largely a recommendation to read the New Scientist article, but there it was: #10 overall. That's odd, I thought to myself. So I clicked on another button to examine the search-engine keywords that people have been using to find that article.

The most common terms weren't surprising: variations on 'best way to die,' predictably, find my piece near the top of Google's search results. But as I began flipping through the search-engine terms that occurred less frequently -- just one or two or three times -- I discovered that some readers seemed not to be searching for a sort of tongue-in-cheek article like the New Scientist's that explores the science behind fatal accidents, but instead appeared to genuinely be looking for information on how to kill themselves.

Searches that readers used to turn up my article include:

best way to die from carbon monoxide
"best way to die" "hanging"
best way to cut vein
best way to die cyanide?
best way to die heroin
best way to die poison monoxide in home
die from hanging whats the best hieght
drowning the best way to die?
exsanguination how long to die
fast way to die
is carbon monoxide a painful way to die
is cutting the arota the fastest way to die
the best way to die now
This is a disturbing thing to learn, that my article may be serving as a resource in some manner or another for people who want to commit suicide.

I'm not unaware of the medical literature on the influence of the internet on suicides. University of Bristol researcher Lucy Biddle and a team of colleagues published an in the British Medical Journal in April that, while acknowledging the potential of beneficial effects of internet use in preventing suicide by connecting patients with support communities and other helpful information, also showed that 19% of search engine hits for terms similar to mine (such as "how to kill yourself") pointed to pro-suicide sites.

Now, of course, I don't believe that means that my article was necessarily in bad taste -- there's nothing wrong per se with writing or reading about death -- but I can't help but worry that things I wrote about an "optimal way to go" could be used by readers who want to do themselves harm.

But at this point, there emerges a journalism ethics question: Is it incumbent upon a journalist to protect the public from information that could cause someone harm?

I think the answer is that there is no easy answer. I can think of cases where the answer is yes, and clearly so -- publishing the military's troop movements, for instance, or printing the home address of a public official or celebrity -- but what about opinion articles or editorial cartoons (as in the outrage over the Danish cartoons of Muhammad, which sparked riots), or cases like mine in which the information is based on science and was never private to begin with?

Rather than remove potentially harmful information --
Biddle et al sensibly write: "Any attempt to regulate suicide promotion needs to strike a balance between freedom of expression and public protection and the global nature of the internet" -- the report recommends:
"It may be more fruitful for service providers to pursue website optimisation strategies to maximise the likelihood that suicidal people access helpful rather than potentially harmful sites in times of crisis."
What the report is referring to is efforts to influence search-engine rankings (a field called search-engine optimization, or SEO), but I think the concept can be applied just as well in my case.

The solution, then, it seems to me, is to append a short warning to the article to provide readers with the website addresses and telephone numbers of suicide hotlines ( and ). Just in case.


Canadian MDs get their own social network

Canadian doctors now have access to the 21st-century equivalent of the doctors’ lounge with the release last month of a social and professional networking website created by the Canadian Medical Association (CMA).

Modelled in part after existing social networks like the incredibly popular Facebook and Sermo, a social network for American physicians, the new website, named Asklepios for the Greek god of medicine, will give doctors a private place to talk to one another about anything from clinical techniques to their golf swings (except protected information, of course, like identifiable information about patients).

“It helps connect physicians with their colleagues across the country, facilitates the sharing of best practices, and fosters a deeper sense of professional affiliation,” lauded CMA past-president Dr Brian Day in a news release.

After a small but successful four-month pilot test of the site, now available at , the CMA envisions rapid growth in membership among doctors and medical students from across the country.

The idea for Asklepios began last year when Jay Mercer (pictured above using the site), a technologically inclined Ottawa family doctor and the medical director of the web division of CMA subsidiary Practice Solutions, was thinking about a hobby of his: ham radios.

While on a ship to Alaska, struggling with his radio’s reception, Dr Mercer turned to, an online community of amateur radio enthusiasts. In short order, a fellow radio operator from Florida made a call on his behalf and wrote back with detailed, technical instructions in answer to Dr Mercer’s question. His radio humming along smoothly as the boat chugged ahead, Dr Mercer realized something profound: “Doctors are like ships passing in the night,” he thought to himself. The medical community is huge and the answer to almost any imaginable question is surely out there somewhere, but doctors have no way to access one another’s knowledge.

If Dr Mercer could get advice from complete strangers about something as esoteric as the intricacies of broadcasting at sea, why shouldn’t Canada’s doctors -- and, by extension, their patients -- benefit from the same kind of innovative technology? (After all, other recent social networks have targeted far more unlikely audiences: Totspot, for children; A-Space, for CIA and FBI agents; First Wives World, for divorcées, OpenBottles, for oenophiles; or Elftown, for sci-fi fans -- to name just a few.)

Back on dry land, Dr Mercer set about designing what would become Asklepios.

Asklepios is gated in order to permit only users with CMA member numbers to register. Privacy is crucial: in an open forum, where patients could read doctors’ comments, no one would feel comfortable posting their opinions. But in Asklepios, doctors have already discussed delicate matters amongst themselves, like the best way to give kids their immunization shots, how to use your iPhone in your practice, and advice on electronic medical records, for instance. (Dr Mercer has already changed one element of his clinical practice since Asklepios began operating: he read some interesting advice on Pap smear technique and learned to do the procedure better than he had done it before.)

Unlike , however, doctors’ comments will not be pseudonymous. “We wanted a highly professional, secure environment where doctors feel comfortable enough to use their names,” says Dr Mercer. “You can connect on a personal level.”

The matter of real names vs pseudonyms is the biggest difference between Asklepios and Sermo, because Dr Mercer is hoping Canadian doctors will choose Asklepios over Sermo which has plans to soon expand internationally. Sermo had initially hoped to enter the Canadian market before the end of the year, but that date has now been pushed back to “early 2009,” says a spokesperson. The CMA has also beaten the American company , another potential competitor, to the punch. “We are planning to open the site to international physicians,” says Erin Mulgrew, the company’s communications director. “We’re just working on the back end of that” to make sure it’s possible to verify that users are really doctors. That process isn’t a problem at the moment in the United States -- “Right now we verify with the DEA [Drug Enforcment Administration],” says Ms Mulgrew -- but the CMA has a leg up on them in Canada: when a user attempts to register for Asklepios, the software checks the name against the CMA’s already-verified database of all Canadian physicians and residents, including doctors who are not CMA members. (Several other similar sites, including Tiromed and New Media Medicine, allow anyone to register.) expects to be up and running in Canada by the end of the year, slightly ahead of Sermo.

Another salient difference between Asklepios and its commercial competitor, Sermo, is the revenue question. Sermo is privately owned and makes money by selling read-only access to the site to pharmaceutical companies, who are itching to hear doctors’ unfiltered opinions about their drugs. “[Asklepios] is a service for doctors,” says Dr Mercer. “It’s built as a private physician community, and there is no plan to monetize it. The CMA would not have any appetite for that type of thing.”

Uptake hasn’t picked up to full speed, in part because the marketing campaign to all CMA members hasn’t begun in earnest yet; the site’s launch last month was only to attendees of the annual meeting. As of September 23, the CMA reported that over 350 physicians had registered for Asklepios, but a spokesperson predicted many more soon to come after the site is marketed to the organization’s entire membership.

At the CMA’s annual meeting in Montreal last month, I sat down with Dr Mercer for a tour of the site. The platform ran smoothly and looked slick; the design was simple and clear. Especially for a site that had been only an idea about seven months prior, the product was very attractive and well thought-out. The most important part of the site, the forums in which doctors can write comments back and forth to one another, was very easy to read in textual and design terms. (A slew of new features slated to be released this month weren’t ready when Dr Mercer showed me the site, so I can’t comment on them. Planned additions include blogs, audio, photos and videos.)

It occurred to me that the CMA has done an admirable job of creating a social networking site -- some of which, like Facebook, can be overwhelming to people not well versed in the web -- that even the most technology-averse physicians could grasp without much of a struggle.

Photo: Sam Solomon


What's in the news: September 24 -- More shocking news on Tasers, dance medicine and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 24.

More details on the September 14 Tasering incident in Halifax: When paramedics ran into trouble getting a diabetic man with low blood sugar to calm down, police suggested an "alternative therapy" and shocked him, causing him to scream, bite off part of his tongue and lose the ability to walk for three days. A Taser company medical advisor says that might well have been the police officers' safest decision. []

The man accused of stabbing a fellow bus passenger in the chest in Northern Ontario should not have been discharged from a Wawa, Ontario, hospital when he requested psychological help, his mother says. []

Dancers are at extremely high risk of suffering musculoskeletal injuries and pain, three "dance medicine" researchers from Toronto report in this month's issue of Archives of Physical Medicine and Rehabilitation. []

Anxious people may be more likely to detect their diabetes early, according to a study published this month in Psychosomatic Medicine by a team of researchers from the University of Waterloo and from Halifax. [] []

Certain types of honey are effective at treating sinusitis, reported researchers from the University of Ottawa yesterday at the American Academy of Otolaryngology-Head and Neck Surgery conference in Chicago. []

On Monday, McMaster University researchers presented a study showing that a shorter course of three weeks of radiation is just as good as a longer one of five for women who have gone through breast-cancer surgery. Follow-up twelve years later showed equivalent rates of recurrence, though the researchers pointed out that it may not be a good option for all patients. They discussed their research on Monday in Boston at the American Society for Therapeutic Radiology and Oncology's annual meeting. []

Doctors see fewer patients near the end of their hospital shifts because of stress and fatigure, reports a Vancouver hospital. []

A cruise ship mistakenly issued a warning to its passengers not to drink the water in Saint John, New Brunswick. []

A new meta-analysis in the Journal of the American Medical Association shows that using an inhaler for 30+ days increases by 58% COPD patients' risk of suffering a heart attack or a stroke, and of dying as a result of one of those causes. Why? Well, the authors have some theories but at this point they're just that -- theories. No one knows. Nevertheless, there is a suggestion in the authors' comments that doctors may need to reconsider the risks and benefits of longterm inhaler therapy for COPD patients. [] [] However, the drug companies behind Spiriva (tiotropium, the drug in many inhalers) say the study is wrong. Arriving in journalists' email late yesterday afternoon was a release from Boehringer Ingelheim and Pfizer filled with data compiled from the companies' research on tiotropium and cardiovascular death, contradicting the JAMA study, which the companies criticize for what they believe was its reliance on too few studies and its failure to distinguish between two different types of anticholinergics: their own tiotropium, and another one called ipratropium. [] Another study, published last week in Annals of Internal Medicine, seems to back up the drug companies' complaint: a team of US researchers (including several who receive grants from Pfizer and Boehringer Ingelheim) reported that ipratropium may raise the risk of death in COPD patients. []

This week's anthology of the best entries from health bloggers, Grand Rounds, is available at KevinMD. []


Tuesday, September 23, 2008

What's in the news: September 23 -- Delirium, checklists and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 23.

Elderly patients on statins have a 28% higher risk of post-surgical delirium, according to a new study by a team of Toronto researchers published in this week's Canadian Medical Association Journal. [] MedPage Today on the study yesterday, writing:

[...] Dr. Redelmeier said that on the basis of their study, he and colleagues concluded that it was reasonable to stop statin therapy prior to elective surgery and to resume afterwards. "This costs nothing, and it may be beneficial," he said, "but reasonable physicians may disagree about this recommendation."
In fact, one reasonable physician has already disagreed with it. In the same issue of the CMAJ, Harvard Medical School physician Edward Marcantonio criticizes the study's conclusions based on what he believes to be methodological problems, calling the results "plausible" but insisting that the connection must still be confirmed. "What is the clinician to do right now?" he asks. "Unlike the authors, I believe it is premature to recommend stopping the use of statins in elderly surgical patients. The methodology used in this study is simply too limited to compel practice change." []

Officials are looking into allegations that a man died after spending 34 hours in the emergency room in a Winnipeg hospital. []

On the fifth anniversary of Insite, Dr Julio Montaner, the BC-based president of the International AIDS Society, called the Conservative government's anti-harm reduction policy "genocide." "These people, they have no morals. They want these people (addicts) gone," he said. [] For someone who's been accused by the federal health minister of becoming an advocate rather than a scientist, Dr Montaner's words are particularly bold and unapologetic: what is clear is that he is supremely confident that the results of his extensive research on Insite are accurate and that they demonstrate the facility's immense value.

Just a week after Ontario doctors were offered a 12.25% raise over the next four years, Manitoba's doctors have signed a deal for a 16.5% raise over three years. [] As seems to be normal these days, the new deal was signed around six months after the last one expired. These delayed and endless negotiations are endemic across the country when it comes to physician remuneration. Everyone knows it's a complicated subject, but six months? That's outrageous -- especially when it happens again and again.

After much news of criticism yesterday of the opening of the private Copeman Healthcare Centre in Calgary, (the Canadian Press that one protester accused owner Don Copeman of stealing her family doctor) Western Standard magazine launched a broadside against "the advocates for maintaining the government monopoly on healthcare delivery in Alberta." []

More depressing financial news from south of the border: with the US economy in a tailspin, Americans are cutting back on health spending, seeing the doctor less (to avoid co-pays) and declining to fill prescriptions. []

Dr Peter Pronovost, the Johns Hopkins researcher who's been pushing the use of simple but surprisingly effective checklists in hospitals, is one of four physicians selected as recipients of this year's $500,000 MacArthur "Genius Awards." [] Graham Lanktree wrote about Dr Pronovost's work in the National Review of Medicine, and the influence he's had in Canada, earlier this year. [] An aside: another winner is the excellent classical music critic .

Lucy Maud Montgomery, the famed Canadian author of Anne of Green Gables, committed suicide, revealed her granddaughter in an article in the Globe and Mail. []

Lawsuits against bloggers are becoming increasingly common. [] I recently wrote about a lawsuit in Boston in which a physician's blog resulted in him being forced to settle a serious malpractice case. []

And, the best from Canada's physician bloggers:

Dr Arya Sharma, using a new study as evidence, dissects the claim that obese patients shouldn't be eligible to have knee replacement surgery. []

In a dictated consultation letter: "... and would appreciate if you would blow the patient together with me." []


Monday, September 22, 2008

What's in the news: September 22 -- Rock talk, BC abuse, David Blaine and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 22.

All three Newfoundland gynecologic oncologists who had threatened to leave the province have agreed to stay after Premier Danny Williams finally offered them extra money to bring their recent raises in line with the rest of Newfoundland's oncologists. "We have to come up with the money in these circumstances, but when you're in the middle of a collective agreement, to step outside of that collective agreement and try and deal with a matter, it's a dangerous precedent," Mr Williams told CBC News. "But when you're talking in terms of patient health and safety, and well-being, and health care, then sometimes you just have to step up." [] []

A new private clinic operated by Don Copeman opens today in Calgary, sparking criticism from a pro-medicare group. [] Read the National Review of Medicine's report on Mr Copeman's expansion plans from January this year. []

Complaints of girls' mistreatment at the hands of physicians in British Columbia detention system, include accusations of sexual abuse, have led (over a year later) to recommendations from the province's independent children's watchdog agency on policy changes to avoid future problems. []

Medical researchers in British Columbia claim to have identified a new neurological disorder in which sufferers are chronically lost. []

The Alberta Medical Association is demanding a clear pandemic plan from the province's new Health Services Board. []

Former New York City mayor Rudy Giuliani takes a few potshots at Vancouver's Insite. []

Dr Yves Bolduc, Quebec's health minister, gets profiled by Quebec City journalist Julie Lemieux. One tidbit: like many successful doctors, he can get by on just a few hours of sleep a night. [, French only]

A Globe and Mail analysis of Justin Trudeau's workout. []

In an article on poverty and children's health in the journal Healthcare Quarterly, Children's Hospital of Eastern Ontario president/CEO Michel Bilodeau prescribes a series of treatments to reduce the burden of poverty on children's well-being. []

The Canadian Medical Association takes credit for getting healthcare into the election spotlight. []

The Canadian Institutes for Health Research is the target of a con: "Chelsea," who claims to be a CIHR employee, is offering to pay people to participate in a study, but she needs them to pay a refundable $50 fee to register. "Please be advised," writes CIHR in a notice to the public today, "that this is a SCAM, and not a legitimate research
study." []

Is it almost time for a Liberal-NDP merger? []

In the mostly overlooked Alberta Liberal leadership race, between the party's deputy leader, a doctor and a pharmacist, there hasn't been much to miss, reports Don Braid. []

Electronic, smokeless cigarettes don't help smokers quit, the WHO says. Also, these products have not been tested for toxicity or other potential safety problems. []

John McCain probably regrets writing that deregulatory measures that succeeded in the US banking industry can do the same for the healthcare sector. Oops. []

David Blaine, the ostentatious American magician, risks going blind from his latest stunt, in which he plans to hang upside down in Central Park for 60 hours. []


Friday, September 19, 2008

What's in the news: September 19 -- Election talk, a Newfoundland fight and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 19.

The Canadian Medical Association Journal has published the responses of all five major political parties to a list of 10 questions on healthcare. Read the CMAJ's overview (PDF) and the responses to each question (PDF).

The rift between the Newfoundland government and the province's medical association is larger than ever after Premier Danny Williams accused medical association president Rob Ritter of interfering unhelpfully in negotiations to keep disgruntled gynecological oncologists in the province. []

New clinical practice guidelines released yesterday by the Canadian Diabetes Association urge doctors to identify and treat a condition known as "prediabetes," which can lead to full-blown diabetes. [ (PDF)]

Paracetamol (marketed as Tylenol) use in children might lead to asthma and several other conditions, report researchers in this week's asthma-themed issue of The Lancet. [] []


Thursday, September 18, 2008

Canada's healthcare protectionism violates NAFTA, claims businessman

For the first time ever, the Canadian government is facing a legal threat over the question of whether restrictions on foreign private investment in the healthcare sector are in violation of the North American Free Trade Agreement (NAFTA), Embassy magazine's Luke Eric Peterson reports in published yesterday.

Mr Peterson writes:

Successive governments—both Liberal and Conservative—have long insisted that Canadian trade negotiators succeeded in "grandfathering" medicare under the North American Free Trade Agreement. In other words, our health care system -— at least as it stood in 1994 when the NAFTA came into force —- is beyond the reach of foreign insurance companies and HMOs seeking to re-model it after the U.S. system.

What's less clear, however, is whether the ongoing flirtation by various provinces with greater private financing and delivery of certain forms of health care is slowly eroding Canada's legal defences.

At least one American citizen is keen to find out.
A lawsuit is being threatened by Melvin J Howard, the CEO of the Arizona-based Centurion Health Corporation, who spent five years and millions of dollars trying to build a $154-million private surgery clinic in British Columbia -- it was envisioned to be the largest such clinic in the country -- but he claims he was chased off by British Columbia cities' "politically motivated" zoning rules and bylaws because his business is American.

Mr Howard's case, as he lays it out on (he first threatened to sue under NAFTA as early as ), is based on the following logic:

1. Recent reforms in various Canadian provincial healthcare systems (including the Supreme Court of Canada's 2005 ruling in Chaoulli v Quebec) have created new private investment opportunities for Canadian businesses.

2. NAFTA dictates that American, Canadian and Mexican businesses must have equal opportunities in all three countries.

3. Centurion wasn't able to take advantage of the same opportunities some private Canadian companies have -- because, says Mr Howard, his business is based in the US.

Ergo: NAFTA violation.

Or so claims Mr Howard. But Embassy's columnist, Mr Peterson, doesn't seem to be convinced yet. Though he writes that a healthcare-related NAFTA challenge has been a long time coming, he implies that this case isn't necessarily going to be the next softwood-lumber dust-up:
As someone who specializes in writing about these types of cross-border lawsuits, I should caution that not every such threat leads to an actual arbitration under the NAFTA. Moreover, even when arbitrations are launched, that doesn't always mean that investors can convince a panel of arbitrators that they have suffered breaches of NAFTA protections owed to them.

And at this stage there are more questions than answers about Mr. Howard's allegations.
At the end of August, Mr Howard and the Canadian government exchanged correspondence about setting up a consultation to discuss Mr Howard's claims. But with Prime Minister Stephen Harper clearly about to call an election at the end of August, Mr Howard said he would put a hold on talks until after the October 14 election is decided.

"At that time," , "Centurion will proceed [and] if after the consultations there appears to be no resolution we will move to go to arbitration."

Update, September 19: The largest labour union in Canada, the Canadian Union of Public Employees, is taking this matter very seriously. "For everyone who thought health care was safe from NAFTA, this is a reality check," said national president Paul Moist in . "The threat also exposes the serious risks that follow from the privatization schemes British Columbia and other provinces have allowed to creep into their health care systems. NAFTA threatens to transform that modest flow, if it is not immediately abated, into a torrent," said says Stephen Shrybman, a trade laywer.



What's in the news: September 18 -- Tasers, the Wii Senior Olympics and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 18.

Nova Scotian medical examiner Dr Matthew Bowes has concluded his investigation into the 2007 death of schizophrenic Dartmouth resident Howard Hyde while he was in custody about 30 hours after police shot him with a Taser. His findings? Mr Hyde died of a "excited delirium," and his death was unrelated to the Taser shock and therefore accidental and in no way the liability of the police. [] But "excited delirium" is not a recognized medical condition; the American Civil Liberties Union has derided the use of the term as a way of "white-washing" the deaths of inmates, as National Review of Medicine article reported last fall.

Coincidentally, yesterday, another Canadian died after being Tasered by police while in custody, in Toronto. By one count, 23 Canadians have now died after being Tasered. []

The government of New Brunswick has finally relented and agreed to review its policy limiting the number of doctor billing numbers that can be issued to certain geographical regions. The policy was intended to make sure enough doctors would be available to work in rural areas, but the medical community has long railed against the regulations. []

Welcome to the Wii Senior Olympics! From September 27 to October 3, Toronto-area senior citizens will be competing for Nintendo supremacy in a grueling set of video game matches of virtual tennis, virtual golf, virtual bowling and the virtual triathlon of all three games. The competition is being held by Lifecare Operations, a long-term care company. []

The Canadian Lung Association endorses the Conservative plan on cigarillos and tobacco, which would ban the sale of individual smokes and outlaw the use of kid-friendly flavourings like cotton candy and bubble gum. [] []

The federal minister of agriculture, Gerry Ritz, has apologized for making some rather unpleasant jokes about the Canadian listeriosis outbreak. [] Meanwhile, the Maple Leaf sanitizing plant in Toronto, which has been implicated in the spread of the bacteria, is set to reopen next week. []

The College of Physicians and Surgeons of Ontario has removed a threat of disciplinary action from its draft policy warning doctors that they could face complaints from the Ontario Human Rights Commission if they refuse to perform any medical services because on religious or moral grounds. (Today the College will debate its draft policy in order to finalize it.) [] Margaret Somerville, the founding director of the McGill Centre for Medicine, Ethics and Law, expresses her support for doctors' freedom of conscience, and reports that Alberta's physician licensing body is considering the matter now. []

An incentive program tested in four BC hospitals' emergency rooms was successful in reducing wait times. []

Dr Keith Martin, a Liberal MP from British Columbia and a former physician, was exaggerating when he threatened to leave politics because of his frustration that getting anything done was so difficult. He's not going anywhere... so long as he keeps winning elections. []

Bisexuals' mental healthcare needs are not being met, reports a new study from Toronto's Centre for Addiction and Mental Health. []

To prevent the onset of heart disease, Dr Yoni Freedhoff, an Ottawa family doctor and obesity specialist, ate a whole bag of President's Choice Two-Bite Brownies. []

Grey's Anatomy, the phenomenally popular hospital soap opera, partnered with the Kaiser Family Foundation to insert some information about HIV into the plot of their show. Kaiser researchers have now announced that viewers learned a surprisingly large amount about HIV from watching. []

Do "doctor moms" suffer higher rates of pregnancy complications because of the physical demands of their work? The Boston Globe reports that Columbia University researchers are studying that question now, while other researchers look at the way expectant and new mothers are treated in the medical profession. []

The latest edition of Health Wonk Review, a collection of the best recent blog entries on health policy, is online now. []

On Friday, an interesting medical ethics conference comes to Edmonton: "Between a Rock and Hard Place: When Healthcare Providers Experience Moral Distress," the second iteration of the meeting held in Calgary in May. Hosted jointly by the College and Association of Registered Nurses of Alberta and Alberta's Provincial Health Ethics Network, the September 19 full-day conference will feature speakers from across Canada and the US. []


Wednesday, September 17, 2008

What's in the news: September 17 -- Listeriosis blame, burns, budgies and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 17.

The proposed agreement between the Ontario government and the province's physicians is flawed, Ontario NDP health critic France Gélinas tells But she doesn't believe the deal is bad because it doesn't pay doctors enough -- quite the opposite, in fact. "[A]s with the last agreement in 2005, physicians’ salaries are going up and promises of better access to care and reduced wait times are being made," she said. "But paying physicians more in 2005 did not improve access to care or reduce waiting lists - so why should it now?" Ms Gélinas decries the government's failure to link funding with real changes, instead pouring more money into an increasingly out-of-date fee-for-service model rather than community health centres, health promotion, chronic disease management and more funding for other providers.[] In other news on the tentative Ontario deal, Ontario Medical Association president Dr Ken Arnold is refusing all interviews this week, Canadian Medicine has been informed.

Canadian researchers have made a major advance in oncolytic virotherapy, a cutting-edge area of research that seeks to use viruses to kill cancer cells. Scientists from Montreal and Ottawa report in the journal Proceedings of the National Academy of Sciences that another type of molecule, called histone deacetylase inhibitors or HDIs, can prime the cancer cells to be targetted by a virus that is harmless to normal human cells but fatal to cancer cells. Experiments have so far been limited to laboratory work, but human trials could begin within a year or two, McGill's lead researcher says. []

Journalists in Sault Ste Marie, Ontario, were expelled from a meeting about the future of the region's healthcare. []

The Canadian Medical Association Journal editorial board blames the Conservative government for dismantling the food-inspection system and allowing self-monitoring. The editors call for a public inquiry into the matter. []

Canada's healthcare system doesn't compare favourably to those of most Western European nations, reports the Frontier Centre. [] Given all the other, similar discouraging studies we've heard over the years, this should come as no surprise.

Don't miss this excellent Toronto Star feature on bonding among severe burn victims, and how burn care works. []

An update on the case of the Moorish-American parents who were arrested in Toronto after bringing their allegedly malnourished infant to the hospital but refusing treatment: the mother has been released on bail and the father is being held until his hearing tomorrow. []

The controversial retired hockey player Eric Lindros donated $5 million to the London Health Sciences Centre, which the Canadian Press reports is believed to be the largest one-time charitable donation ever by a Canadian athlete. []

A Canadian weight-loss supplement company, Wellnx Life Services, is being sued by customers in sixteen US states. []

Canada becomes the first country in the world to approve the new anticoagulant rivaroxaban to prevent venous thromboembolic events (VTE) after hip and knee replacement surgeries. The once-daily pill has proven to have significant benefits over the current treatment, enoxarapin, with similar rates of side effects like bleeding. [] The drug's effects were demonstrated in a large trial (funded by Bayer) the results of which were published in The Lancet's July 5 issue. [ abstract] [ (subscription required)]

Prosthetic ears?! [] []

A fascinating take on 23andMe, a DNA testing company, and the potential future of personalized medicine -- as well as social networking. []

Here's the latest and greatest from blogs written by Canadian physicians:

In "A Bird's Eye View of Family Medicine," a retired Okotoks, Alberta, family physician, who ponders our country's health policy problems at What's Wrong with Healthcare?, writes:

Over the past four to five days I have noticed that my budgie bird, Jo-Jo, was becoming a “Star Gazer”. In medical terms, he was developing a torticollis. Now to appreciate the story, you should know that I inherited this bird from an elderly couple in my practice, when during a house-call, they asked if I would take Jo-Jo if anything ever happened to them. They said he liked me, and besides, their daughter had a cat. In a moment of insanity (my wife hated birds), I agreed. Some two years later both of these dear elderly folks passed on and I prayed that they told no-one of my promise. Unfortunately, the daughter showed up in my office a few days later with bird, bird cage, bird food, and various other bird paraphernalia. My wife was not pleased and I barely escaped the couch the first night.
The budgie's neck problem leads the author to a novel solution to the shortage of primary care providers in Canada, believe it or not. (I'll give you a hint: more money.) []

Alberta Liberal leadership candidate and former public health physician David Swann on the environment and health: they're "two sides of the same coin," he says. []

Dr Michelle Greiver dissects the debate on hosting electronic medical records locally vs remotely. []

Speaking of electronic medical records, CanadianEMR just introduced its weighted medical records software rankings, vastly increasing the value of its already impressive user-rating system. []


Tuesday, September 16, 2008

CMA issues healthcare challenge to political parties

In an sent today to the leaders of the five largest political parties, Canadian Medical Association president Robert Ouellet (right) demands responses from each on the six most pressing healthcare problems facing the country today.

As well, Dr Ouellet asks each party to release their healthcare platform by September 29 at the latest so the public has time to weigh the different proposals before the election on October 14.

The CMA won't endorse anybody, but the party's platforms and their answers to the CMA's questionnaire will become part of the organization's Voter's Guide, to be published October 3 at .

The six healthcare problems that Dr Ouellet wants to know the party's positions on are:

- the doctor shortage
- mental health
- innovation and information technology
- access to prescription drugs
- health and the environment
- sustainability of the health care system
Before October 3, when the Voter's Guide will come out, the CMA is providing election coverage for physicians at .




With the election campaign gearing up and the leaders hopping back and forth across the country in search of votes -- but with still of health policy thus far -- I decided it would be a good idea to find out when the major political parties' healthcare platforms would be available, to help plan our coverage. So I made a few calls.

The young man who answered the phone at the Liberals' media relations office had the answer at the ready: the full platform will be available on September 22 -- next Monday.

The Green Party informed me their platform comes out on September 17.

The NDP's media relations department couldn't give a specific date for the release, but they were very accommodating about putting my name on the list of reporters to be notified when the platform is published.

The Bloc Québécois, which doesn't really have any obligation to draft a full health platform beyond reiterating their mission to extract as much funding as possible from Ottawa, has already made public their . (Other than a timely section on food-safety inspections and a few other sensible but predictable concerns, healthcare doesn't play a terribly large role in the Bloc's platform.)

And the Conservative Party -- which has been with the for -- was not only unwilling to give me an idea of the date when their healthcare platform would be released. In addition, their media relations officer told me that there would be no point taking down my name and contact information, because the Prime Minister will be rolling out parts of the party's platform as the campaign progresses and I'll hear about it when he announces it. End of conversation.


What's in the news: September 16 -- Ranking the provinces, rural reluctance and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 16.

The Frontier Centre for Public Policy, an independent think-tank based in Winnipeg, released its first Canada Health Consumer Index, which ranks the provinces' healthcare systems rank as follows:

1. Ontario
2. British Columbia
3. Nova Scotia
4. New Brunswick
5. Alberta
6. Prince Edward Island
7. Manitoba
8. Quebec
9. Saskatchewan
10. Newfoundland and Labrador
A short mention of the Frontier Centre study on the St John's Telegram's website has already attracted a number of angry comments, lambasting Newfoundland and Labrador premier Danny Williams. [] [Full study available as PDF from the ]

As Liberal leader Stéphane Dion's campaign continues to struggle, speaking at Dalhousie University's medical school (where Jack Layton announced elements of his proposed health human resources plan yesterday) Mr Dion this morning announced that his government would create a national catastrophic drug coverage plan. This is a promise Canadians have heard before from federal politicians -- and the premiers are all for it -- but still no progress has been made. []

The parents of an ill nine-month-old child, who was very underweight and suspected by staff Toronto's Hospital for Sick Children of being malnourished, were arrested yesterday after a week-long search across the city. The child was taken into the custody of the government's Children's Aid Society. It turns out the parents are members of a "religious sect" (The Globe and Mail was careful not to use the word "cult," for sensitivity reasons, one assumes) called the , which seeks to unite North American "Free Negroes" are really citizens of Morocco. "She's not an evil person and she's not a bad mother... We have the rights as Moorish-Americans not to succumb to institutionalized ways of healing ourselves," said her "spiritual leader" Grand Sheik Brother Kudjo Sut Tekh El. []

An Ontario coroner's inquest began yesterday, to investigate the death of Jeffrey James. Mr James died at the Centre for Addiction & Mental Health in Toronto in 2005 after he was tied down to his bed for five days in a row because he had engaged in a "sexual act" in the hospital. Ontario's chief coroner has testified that Mr James died as a result of blood clots that reached his lungs, caused by his being tied down. []

Acyclovir, long believed to be useless in HIV but effective in controlling the herpes virus, can actually attack HIV in patients with both that virus and herpes, according to a new study published in Cell Host and Microbe by an international team of researchers including one from McGill. [] []

Saskatchewan's nurses' union has filed a Charter challenge against the province's essential services legislation, which was passed by the recently elected Saskatchewan Party majority government earlier this year. []

A Quebec group advocating a provincial newborn hearing-screening program congratuled several Montreal hospitals on their decisions to begin screening programs, but urged the government to follow suit across Quebec. []

Dr Trevor Theman, the registrar of the College of Physicians and Surgeons of Alberta, is nervous about this past summer's (PDF) by the Council of the Federation, the assembly of Canadian provincial premiers, on labour mobility for professionals including physicians. In the September issue of the College's newsletter, The Messenger, Dr Theman writes:
I am very concerned that the premiers’ direction addresses one social good, that of labor mobility, but ignores (and may destroy) another - that of ensuring we have physicians working in rural, remote and underserviced parts of Canada. [...]

What might happen if free, unfettered labor mobility is mandated? Well, Newfoundland, Saskatchewan, rural Manitoba and northern Alberta may find themselves with no (or significantly fewer) physicians. [ (PDF, page 3)]

The chemical found in many plastics, Bisphenol A (BPA), has deleterious health effects if it accumulates in humans, according to a new study published today in JAMA. Potential risks include heart disease, liver problems and diabetes. Canada has already restricted the use of BPA, labelling it a "toxic chemical" in April, but the United States has not done so yet. [] []

New data from the DIRECT Program, described as "the first large-scale study program assessing the effect of treatment with an angiotensin receptor blocker (ARB) on the incidence and progression of diabetic eye complications," shows moderately positive signs on the potential benefits of prescribing the drug candesartan to Type 1 and Type 2 diabetics. Type 1 patients who had diabetic retinopathy at the start of the trial didn't get any help from the drug, but diabetics in the test group who had early signs of the disease or who hadn't yet contracted it saw up to one-third better outcomes than those in the placebo group. The study shows some promise for microvascular treatment solutions for diabetic retinopathy. Renowned Montreal General Hospital endocrinologist/internist Robert Gardiner is one of the international coordinators of the trial. The new data was presented last week at the European Association of the Study of Diabetes congress in Rome, and a full article is to come soon in The Lancet. [Takeda UK, AstraZeneca Canada, and others]

Remember the infamous Walter Reed Army Medical Center scandal by the Washington Post? Mother Jones magazine claims to have uncovered another military healthcare snafu: the Pentagon's $20-billion electronic medical records system, which now allegedly lies in shambles. []