Canadian Medicine

Within 24 hours of the release of the Goudge inquiry's report on pediatric forensic pathology in Ontario, a number of complaints have already surfaced about certain aspects of the commission's work.

THE WRONGFULLY ACCUSED
William Mullins-Johnson, of Sault Ste Marie, Ontario, has been the most high-profile of the province's false conviction cases over the past two decades. He was jailed in 1993 for the rape and murder of his niece, until, in 2005, a review of the original investigation by the pathologist on the case, Dr Charles Smith, revealed that the girl had not been murdered or raped, and Mr Mullins-Johnson was released on bail, and acquitted in 2007. Justice Stephen Goudge's report yesterday didn't go for enough, in Mr Mullins-Johnson's opinion. A Canadian Press article :

While the report found the failings of an "arrogant" forensic pathologist and his bosses were at the heart of the miscarriages of justice, William Mullins-Johnson said those responsible need to be held to further account.

"If they can't, then this whole thing of restoring public confidence goes for naught," said Mullins-Johnson, 38, who spent 12 years in jail for the rape and suffocation of his niece, who actually died of natural causes.

"They invented a crime. They pulled it out of their head and said, 'This guy is guilty of this.'"

Stephen Goudge's findings and 169 recommendations do offer a "little" comfort, said Mullins-Johnson, who added that his horrendous experience still gets "under his skin."

It should be noted that Justice Goudge's report was not mandated to recommend criminal or civil charges, but Mr Mullins-Johnson's frustration points to the fact that the Charles Smith saga is far from over. Victims of his errors and falsehoods must still be compensated, and many cases must still be reexamined before that can be accomplished.

Justice Goudge's report, despite its inability to get into criminal matters, did deal directly with the effect of Dr Smith's errors on Mr Mullins-Johnston. On page 5 of (PDF), the report recounts an exchange between the two men during Dr Smith's appearance to testify at the inquiry:

DR. CHARLES SMITH: Could you stand, sir?

(BRIEF PAUSE)

DR. CHARLES SMITH: Sir, I don't expect that you would forgive me, but I do want to make it -- I'm sorry. I do want to make it very clear to you that I am profoundly sorry for the role that I played in the ultimate decision that affected you. I am sorry.

MR. WILLIAM MULLINS-JOHNSON: For my healing, I'll forgive you but I'll never forget what you did to me. You put me in an environment where I could have been killed any day for something that never happened. You destroyed my family, my brother's relationship with me and my niece that's still left and my nephew that's still living. They hate me because of what you did to me. I'll never forget that but for my own healing I must forgive you.

Justice Goudge's section on Dr Smith's errors and manipulations of oversight is followed by a fascinating portrait of the doctor's character. Acknowledging Dr Smith's incompetence and deception, Justice Goudge writes:

... his deeply held belief in the evil of child abuse caused him to become too invested in many of these cases...

Dr. Smith is a complex multi-dimensional person. The terrible irony is that, in some ways, the negative attributes I have described were compounded by positive qualities. He was willing to take on difficult pediatric cases that his colleagues were not anxious to do. He has a sense of responsibility that led him to cooperate with the work of this Inquiry. In his evidence, he admitted many of his shortcomings that the evidence had laid bare. And, albeit much too late, he owned up to a great deal. In addition, the evidence is clear that others found him engaging. Support staff liked working with him, and many people found him a charismatic and effective speaker.

Despite Justice Goudge's thorough work -- particularly his explanation of the root causes of the justice system's disastrous failures and the commission's success at evoking an apology -- the report does not and could not deal with criminal issues, meaning Mr Mullins-Johnson cannot be entirely satisfied with the inquiry's results. But it remains to be seen if may yet be more fallout in regards to Charles Smith.

CHILDREN'S RIGHTS ADVOCATES
The organization Defence for Children International-Canada, a children's rights nonprofit, yesterday released criticizing the report's omission of an analysis and a plan about what to do with the siblings of children whose deaths were misclassified as murders or otherwise incorrectly investigated, some of whom are now in foster care or have been adopted or otherwise separated from their falsely accused parents.

William Sparks, the organization's president, and Les Horne, its executive director, wrote:

There is no process in place to identify some of these children even to let them know that their parent has been exonerated.

Defence for Children International-Canada calls on the Ontario Minister of Children and Youth Services to address the moral, ethical and legal obligations to young people whose lives have been devastated as a result of wrongful separation from their families. Specifically, we call for the establishment of a Task Force to deal with the child welfare issues arising from this Inquiry and to develop a process to remedy the harm done to some of our youngest and most vulnerable citizens.

TORONTO REPORTER HAROLD LEVY
Harold Levy, a retired Toronto Star reporter, has been chronicling the case of Dr Charles Smith and the Goudge inquiry for months online, at . As part of a series he's written over the last 24 hours on the aftermath of the Goudge report's release, an aspect of the report that has so far gone mostly overlooked. Wrote Mr Levy:

... we should not allow ourselves to overlook Justice Goudge's finding that the Hospital for Sick Children - Dr. Smith's employer - "impeded the Office of the Chief Coroner's ability to provide meaningful oversight."

Curiously, the censuring of the renowned hospital is buried almost at the very end of the Inquiry's 278 page volume labelled "Systemic Review"and only takes up four pages in the Commission's overall report.

Goudge explains that from at least 1995 to 1997, Dr. Becker and others at Sick Kids had concerns about the timing and the quality of Dr. Smith's pathology work for the hospital.

"Notwithstanding their ongoing concerns about delays and diagnostic discrepancies in Dr. Smith's work, it appears that no one at Sick Kids took any formal disciplinary action against Dr. Smith, nor did they tell the Chief Coroner's Office about their misgivings."

Mr Levy is dissatisfied with Justice Goudge's failure, in his view, to take the hospital "much more firmly to task."

"Instead," writes Mr Levy, "he recommends that the Ontario Forensic Pediatric Pathology Unit should remain at Sick Kids - a responsibility which it has not demonstrated that it deserves."

Update, October 8: Asked for a comment on the Goudge report’s comments on the role of the Hospital for Sick Children, Judith John, the hospital’s VP communications and public affairs, told Canadian Medicine, “Certainly we support the extensive work of the report, of the committee... which we feel was thoughtful and fair. We are definitely reviewing those recommendations, and are making appropriate changes to the processes.” Ms John refused to answer yes or no as to whether the hospital accepted the report’s conclusions about Sick Kids’s role in the failure to identify and report Dr Charles Smith pathology errors.

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, October 2.

Yet another investigation is launched over a death of someone who was Tasered by police, again in BC. In this case, a man who was seen robbing a bank was followed to his home in Langley, where he subsequently fell out of a second-storey window "naked and bleeding from a chest wound." reports CTV News. He was shot with a Taser as he tried to reenter the house. []

The British Columbia Automobile Association's wait-list medical insurance is illegal, says BC Health Minister George Abbott.

As a New York study on out-of-body experiences at death gets underway, a Montreal team is trying to get approval to do the same thing.

American economist Paul Krugman's admiration for Canadian healthcare was contradicted by some real, live Canadians during a debate last month. (Thanks to Kevin Pho, of KevinMD, for pointing out this link.)

The October 2 edition of the Heath Wonk Review blog anthology is online now, with health-policy news on the US economy bailout proposal, and more.

A new article in the New England Journal of Medicine has sparked debate on executive physicals: beneficial or harmful?

UBC physician and public health expert Erica Frank is the founder and executive director of a new searchable online resource for medical information, called .

The mayor of St John's, Newfoundland, gave a Key to the City to 101-year-old GP/surgeon Nigel Rusted.

With public confidence shaken by wrongful convictions and scandal, Ontario’s pediatric forensic pathology system is in need of major reforms, says the , issued on Wednesday.

The report produced by the inquiry’s commissioner, Justice Stephen Goudge (right), recommends 169 changes to remodel the province's approach to dealing with child homicide investigations.

"These changes are necessary if public confidence in pediatric forensic pathology and its future use in the criminal justice system is to be restored and enhanced," writes Justice Goudge.

In the 1,170-page report, Justice Goudge dissects how the existing system failed in the 1980s and 90s, ultimately leading to the much-publicized wrongful convictions that relied on the expert witness testimony of Dr Charles Smith, the man at the centre of the controversy over wrongful convictions whose own problems were the impetus for the Goudge inquiry's full-system review. But the report makes clear that the blame is not all Dr Smith’s: Justice Goudge directs a great deal of criticism at the failure on behalf of the government and the Office of the Chief Coroner for Ontario (OCCO) to establish effective oversight of the provice’s coroners and forensic pathologists.

“The oversight and accountability mechanisms that existed were not only inadequate to the task,” he writes, “but also inadequately employed by those responsible for using them.”

Justice Goudge’s report accuses former chief coroner James Young and deputy chief coroner James Cairns of lying to officials and to the public in an effort to cover-up Dr Smith’s errors and to protect their own reputations. Justice Goudge suggests giving coroner’s-office oversight responsibilities to a Governing Council.

The report applauds the Ontario government’s efforts to reform the system since 2001 but warns the “more must be done.” “In the last few years,” the report says, “new leadership has made a significant start in addressing this challenge. But as they acknowledge, much more must be done. To stop now risks a return to the troubled years [1981 to 2001] examined at the Inquiry.”

The early Wednesday afternoon touted that progress, but highlighted progress counting back only five years, rather than the seven that Justice Goudge counts. The discrepancy may be explained by the fact that five years ago marks the date the Liberal Party, which currently holds a majority in the Legislative Assembly, came to power. In 2001 and 2002 -- the dates during which Justice Goudge says progress was made, but which today’s press release fails to mention -- the Progressive Conservatives, under Mike Harris and Ernie Eves, formed the government.

Justice Goudge points out, however, that the changes since 2001 haven’t solved the system’s problems. “Inadequate resources continue to undermine the laudable efforts of the new leadership of the OCCO to fix the many problems identified by our systematic review. This situation cannot be allowed to continue,” says the report, urging the province to act quickly to rebuild the forensic pathology system. Particularly crucial in the ongoing lack of resources, Justice Goudge writes, is the shortage of forensic pathologists in Ontario. Several recommendations deal with improving the education and credentialing of forensic pathologists.

Other recommendations in the report include changing the complaints process, starting up a police Child Homicide Team, and creating a government plan to compensate victims of the province’s pathology errors and wrongful convictions.

The Ontario government has promised a compensation plan and new legislation to reform how forensic pathology is conducted in the province.

However, the government's press release did not make clear what would that new legislation would comprise. The release did not declare that the government would accept all of the 169 recommendations, only saying that the new legislation would be “guided by Justice Goudge’s recommendations.” Nor did the release say when drafts of the new legislation would be available, nor whether the government intends to introduce the legislation during the current sitting of the Legislative Assembly. The current session is slated to end December 11.

To read all four volumes of the Goudge report in full, download each of these four PDF files: , , , .

Update, 5:30pm, Wednesday, October 1: We've received a response from Ontario's Ministry of Community Safety and Correctional Services, the government ministry that includes the Office of the Chief Coroner for Ontario. You can read the questions and their answer, from Stuart J McGetrick, Strategic Communications, Communications Branch, below.

Question 1: Your press release today says the new legislation to overhaul the forensic pathology system will be "guided by" by Justice Goudge's recommendations. Will the government adopt all 169 of Justice Goudge's recommendations or not?
Question 2: When can we expect to see this new proposed legislation? Will it be introduced during the current sitting of the Legislative Assembly?

ANSWER: Since 2003, the government has taken steps to improve the province’s death investigation system. One of those steps was to ask Justice Goudge to conduct this public inquiry. As we've only just received the report, it's important that we take the time to thoroughly review its details with stakeholders and our justice-sector partners before discussing the implementation of its recommendations. I can say, though, that the government intends to move quickly and aggressively to respond to the report.

As part of that response, the government is committed to introducing a bill in the fall session that, if passed, will establish a framework that will build on our efforts to date to strengthen the death investigation system, provide for greater oversight and accountability and improve coroner and forensic pathology services throughout Ontario.

Significant progress has already been made to improve the quality of death investigations in Ontario, something Justice Goudge recognized in his report. Justice Goudge’s recommendations will help us make the necessary further improvements.

A new paper, "," published last month in the Journal of Medical Internet Research by a pair of Croatian researchers, reveals the following unsettling news about medical bloggers:

59% "often... spend extra time verifying facts"

7% "often... try to obtain permission for copyrighted material

29% "often... post corrections"

Despite those dismal numbers, the authors of the paper somehow managed to write, "Responding medical bloggers demonstrated a captivating level of adherence to best practices generally associated with journalism."

Baffling. (And it's not the incorrect usage of "captivating" that's baffling, although that's also strange.)

Those figures about journalistic ethics are downright embarrassing, and the authors interpret them as encouraging. I suppose that when you're comparing that data to data for general-interest bloggers, the medical bloggers' ethics seem admirable -- but that's like saying that because Harry Truman and Richard Nixon were disliked so universally, then George W Bush, because of his slightly higher approval ratings, must a popular president. That's a variation on the logical fallacy of a , presenting medical bloggers and general-interest bloggers as the only relevant comparators in terms of journalistic ethics, when that's certainly not the case.

Or perhaps the authors have fallen into the trap of the in their excitement about the promise of medical blogging, flawed though it may be.

What reasonable excuse could there be for looking at those numbers and concluding that the bloggers are following journalistic ethics's best practices?

NB: Canadian Medicine is the editors' blog of Parkhurst Exchange magazine, written by professional journalists. We verify our facts, respect copyright law and post corrections when they are warranted.

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, October 1.

Health Canada's has zero effect on motivation or behaviour, reported two UBC researchers in Psychology, Health & Medicine's latest issue.

The Ontario Court of Appeal dismissed two class-action suits against Health Canada for injuries caused by jaw and breast implants that were approved by the government regulator. The court's ruling declared that the manufacturers are responsible.

New Brunswick's inquiry into the problems with cancer tests performed by a pathologist in Miramichi has finished hearing testimony. Commissioner Paul Creaghan's final report is due by December 31.

Toronto emergency physician Brian Goldman had scheduled an interview with Health Minister Tony Clement for his CBC radio show White Coat, Black Art. But Mr Clement was a no-show. []

Mandatory overtime imposed on some Quebec nurses is causing major problems: nurses in Rosemont held a demonstration yesterday.

New Brunswick's opposition claims $1.3 billion spent by the government's regional health authorities isn't reported transparently.

Dr Jimmy Poon, a Toronto family physician, has had his practice restricted by the College of Physicians and Surgeons of Ontario after he pleaded no contest to charges related to his performing surgical procedures that he was not licensed to perform.

A BC judge decided early last month in R v Spratt that although the law preventing protesters from standing too close to abortion clinics is indeed a breach of the Charter of Rights and Freedoms, the breach is justified.

The Ontario Superior Court of Justice decided in favour of the government in a case in which the Canadian Medical Protective Association and the Ontario Medical Association wanted to keep certain financial information private. The judge ruled that the information, which was part of a memorandum of understanding with the Health Ministry, fell under the province's freedom of information legislation.

A Vancouver Island hospital lost some osmium tetroxide and some low-concentrate uranyl acetate on the weekend, prompting a public alert. Turns out the toxic chemicals had been moved to the lab's new fridge.

The excellent Canadian physician blogger at Rheumination remembers the day Vioxx got pulled: "Since then, of course, all sorts of dirt has been exposed about the drug, and in particular, the company that produced and marketed it. What made it more disturbing was the fact that I prescribed it a lot, even took it myself. I gave talks to other physicians and undoubtedly convinced them to do the same. All my colleagues did the same. We were all taken in."

The November issue of everyone's favourite crazy medical journal, Medical Hypotheses, is out.

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.

DTC IN CANADA?
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

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. [CMA News] 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 here.

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."

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.

COMMUNICATION CATALYST
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.

GENERATION GAP
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: Asklepios, a Canadian Medical Association website, and Sermo, 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

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 here]

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.