Canadian Medicine

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."

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 "Does Canada need more med schools?"

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.

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 "The best way to die," 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 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.

STATION TO STATION
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 www.eham.net, 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.

HOW IT WORKS
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.) RelaxDoc.com 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.

THE ASKLEPIOS EXPERIENCE
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

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.

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. [Canadian Medicine]


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."

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. [Le Soleil, 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.