Canadian Medicine

On Wednesday, Canadians were treated once again to the self-serious pomp of a joint sitting of the two houses of Parliament and the silly, interminable march of the Usher of the Black Rod.

That's right: yet another Speech from the Throne in which our Governor General is compelled to read out about an hour's-worth of truisms, fluff and vague pledges that amount in the end to very little different from the status quo. (Michaëlle Jean deserves a great deal of credit for speaking lines like "This country is made up of every hope we cherish, every dream we pursue, every project we realize" with a straight face.)

Let's take a look at what the government of Canada -- the same government whose leader has declared that improving access to health services is "a priority" for his administration -- plans to do to improve our healthcare system.

To find any mention -- even oblique -- of healthcare in the Throne Speech, you'll have to be patient. Very patient.

As expected, much of the first portion of the speech pertained to the economy and the new deficit that our economist Prime Minister has reluctantly accepted as reality.

Somewhere around halfway through the speech is a section on "Making Government More Effective," which is a favourite trope of supposedly reformist politicians. After I heard "Our Government... will build partnerships with third parties and the private sector to deliver better services at a lower overall cost," I thought perhaps there might be some mention of a new policy on federal support for healthcare infrastructure -- a major expense for provincial governments' tight budgets -- perhaps using the public-private partnerships that have come into vogue of late.

But no. The speech instead veered on back to "reform" talking points: "make sure that spending is as effective as possible and aligned with Canadians’ priorities" and "cut the red tape faced by the private and not-for-profit sectors when doing business with the government." Good luck fixing those things. Still no healthcare.

That was followed by minutes that seemed like hours of vague talk about alternative fuels and energy strategy -- which admittedly wasn't nearly as painful as hearing the science-fiction "energy independence" schemes Barack Obama and John McCain cooked up during the US election campaign this year, when they seemed to be competing to outdo one another with increasingly unrealistic offshore-drilling, nuclear biofuel projections and prognostications.

Finally, as the speech is nearing its end, we at last hear a little bit about health. So, what will Stephen Harper's government do this upcoming Parliamentary session? According to the speech, we can expect to see "creative measures to tackle major heart, lung and neurological diseases and to build on the work of the Mental Health Commission." No further details during the speech. The reason for the brevity in mentioning what sounds like it could be a major new policy is due to the fact that those projects, which Mr Harper , are not exactly "creative" and the measures are relatively modest: $10 million over two years for lung disease prevention, diagnostics and treatment; and $15 million over four years for a study on Alzheimer's and Parkinson's.

The next section, on Canadians' safety, first reiterated some of the government's previous goals on crime and the justice system before getting into the most extensive discussion of health in the entire hour-long speech. And by extensive, I mean one paragraph:

"Safety and security also mean that Canadians must be assured that the food on their dinner table, the toys they buy their children, and the medicines on which they rely are safe. Our Government will follow through with legislation providing better oversight of food, drug and consumer products. It will strengthen the power to recall products and increase penalties for violators. It will also move quickly to launch an independent investigation of this summer’s listeria outbreak and act quickly upon its findings."

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, November 21.

Congratulations are due to Dr Diane Hawthorne, a family doctor from London, Ontario, who won a million dollars when she cashed in a two-for-one breakfast coupon at McDonald's three weeks ago. "This is still unbelievable," she told the London Free Press. "This doesn't happen to people like us." Dr Hawthorne called her husband to tell him she won and he hung up on her. She called back, and he hung up again. (No one likes a prank pulled on them before 8:00 AM.) She was late to see her first patients because she had to stay at the McDonald's to sign the prize contract. Her chances of winning were reported as being one in 591,287,650. "The payout, tax-free, is $50,000 each year for 20 years," reported the Free Press. "That will come in handy for the Hawthornes: of the family's four children, three attend Western and one is studying to become a doctor."

Dr Jean Grégoire, the winner of the 2008 award as Quebec's family physician of the year, has some good advice for politicians -- if only it weren't taboo in Canada to talk about delegating more of the things doctors currently do to nurses and other health professionals.

One third of Canadian physicians reported that their jobs make it hard to live a healthy lifestyle, a new Canadian Medical Association survey found. [CMA News]

Vacated in September by Leona Aglukkaq, who went on to become federal health minister, Nunavut's health minister job now goes to Keith Peterson, a former mayor of Cambridge Bay, business executive and kids' hockey coach. But that's not going to be his only job: he was also named finance minister, minister responsible for the worker's safety and compensation commission, and minister responsible for utility rates review council. Mr Peterson returned to the legislative assembly by acclamation in last month's election.

Former US Senate majority leader Tom Daschle will be nominated as Barack Obama's Secretary of Health and Human Services. Mr Daschle, who played a central role in promoting Hillary Clinton's failed universal healthcare plan in the 1990s, is the author of Critical: What We Can Do About The Health Care Crisis, published earlier this year, which advocated a major increase in the amount of public oversight of private healthcare delivery and insurance, an expanded federal health insurance plan available to everyone, and, unlike Mr Obama's proposal during the campaign, a law mandating the purchase of health insurance by all residents. The Economist called Mr Daschle's appointment a "shrewd choice," writing that it "suggests that Mr Obama understands the main lesson of the HillaryCare debacle: that the hardest thing about any big and tricky reform (and health care is the biggest and trickiest of the lot) is getting congressional approval." Mr Daschle has a serious reformist agenda when it comes to healthcare, which means that "Mr Obama seems to be defying the gloomy view that the state of the economy rules out such an expensive initiative."

In other US healthcare news, Representative Henry Waxman unseated John Dingell to become the chair of the House Committee on Energy and Commerce, the body responsible for regulation of the pharmaceutical and health insurance industries. Mr Waxman said before the final vote that he wanted the chairmanship "because we have a once-in-a-generation opportunity to advance health care, achieve energy independence and tackle climate change." He is widely seen as significantly more liberal than Mr Dingell, who has in the past continually derailed efforts to force Detroit automakers to improve their cars' gas efficiency, in deference to corporate interests and his own Michigan constituency. Slate argues that Mr Dingell has been a "stalwart" liberal on healthcare issues, helping to create Medicare and children's health insurance laws, and advocating for a national health insurance plan, but the article says Mr Waxman will be helpful to Mr Obama on industry regulations related to climate-change.

Xtra takes Ontario Health Minister David Caplan to task for some confused comments on the government's role in providing sex-reassignment surgery.

Here's a brilliant piece of research: "Employees who are sexually harassed experience less job satisfaction and lower job performance." Good work, Chinese University of Hong Kong and Psychology of Women Quarterly.

Researchers in Maine did nine months of research just to learn that kids can get pop and other sugary drinks outside of school, so getting rid of vending machines isn't any help. As the schoolkids I know would say: "No duh."

A University of Missouri study found that anti-smoking ads are effective at grabbing attention when they either scare viewers or disgust them, but not when they do both. "When fear and disgust are combined in a single television ad, the ad might become too noxious for the viewer," Glenn Leshner, a communications researcher and the lead author of the study, said in a release.

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, November 20.

Prince Edward Island gears up for what promises to be a protracted battle over a major overhaul of the province's healthcare system after a consultant's report recommended, among other things, closing one community hospital's emergency department and shifting the focus to locally delivered primary care. "I... recognize that the decisions announced today will be the source of perhaps some controversy, perhaps some debate, but I’m also aware that the long-term future of our health-care system depends on constructive and deliberate change," Liberal Premier Robert Ghiz said. [] Not all the report's recommendations will be enacted, the provincial health minister said, despite a warning from the consulting firm not to "cherry-pick." []

QUEBEC ELECTION UPDATE: While ADQ opposition leader Mario Dumont is busy alienating all those lazy people on the welfare rolls (is his calculus that the unemployed aren't voters?) [La Presse] let's take a brief survey of the latest news on healthcare issues in Quebec. PQ leader Pauline Marois, recognizing her error of last weekend when she said she regretted nothing about her decision as health minister in the 1990s to buy out doctors and nurses to cut costs, has changed her tune. "We had to make difficult decisions. Were we happy to make them? Absolutely not. Would I do that again? Never." The Gazette reported that she blamed the Liberal Party for racking up the deficit that forced her hand back then. "Did we enjoy it? Did we like it? Did we find it pleasant? I can tell you for myself, who has run the two big departments that were affected, I found that damn hard." Mario Dumont said he would cancel plans to build a new French-language superhospital downtown and would put it in Outremont instead. He criticized the amount of money now predicted to be spent on the project beyond what had originally been projected. Jean Charest's incumbent Liberals decided to reverse an earlier decision by offering to cover women's first two in vitro fertilization procedures under the public health insurance plan. The idea had been shot down before by Liberals, who called it unrelated to health and too expensive to cover. Polls still show Mr Charest with a sizable lead, within reach of a majority government.

An expert advisory panel told the Ontario government it should permit pharmacists to diagnosis minor medical conditions, prescribe drugs and adjust doctors' prescriptions. Health Minister David Caplan was receptive to the idea, saying he was eager to work on it. The professional associations of pharmacists and physicians both withheld comments until they could examine the report in more detail. []

Ontario's chief medical officer of health, Dr David Williams, reported that the province's public-health system has improved since reforms were enacted in 2004. However, he said that too many senior permanent jobs in public health across Ontario remain unfilled. []

"Where did health care go?" wonders Globe and Mail columnist Jeffrey Simpson. A hard-nosed political reporter, Mr Simpson simply comes right out and says what many in the healthcare sector have only been willing to imply and hint at: "as a public policy/political issue, health care has died."

The Canadian Institutes for Health Research announced the winners of its awards for the nation's top health researchers. Dr Michael Hayden won for clinical research. Dr Peter Tugwell was recognized for his population health research. The young researcher award went to Dr Charles Cunningham.

Necklaces given out as gifts by the Hospital for Sick Children to kids at the annual Santa Claus Parade on Sunday may present a choking hazard and should be destroyed. []

Oshawa police arrested a man suspected of making a bomb threat at a clinic after failing to receive care.

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

The doctors treating Tom Wilson, the sole survivor of a British Columbia plane crash on Sunday, can hardly believe he not only survived the impact but walked away from it and is now recovering so quickly. "It's really quite remarkable he had no fractures and had no internal injuries," said Dr John Reid. "There's no way he could have went through that and come down without some sort of help," the victim's brother marveled.

The Winnipeg Regional Health Authority decided that no one individual was at fault in the death of homeless patient Brian Sinclair, who died in an emergency department waiting room in September after being left to sit there for 34 hours. The review recommended that "action be taken to address the systemic gaps and that direction be provided to all staff working in the emergency department to ensure that all persons in the waiting room be specifically asked if they are there seeking medical attention." I can't help but wonder... who are these people hanging out in hospital waiting rooms for 30+ hours who aren't looking for medical attention?

Yukon public health officials have reported ten cases of tuberculosis in the territory this year, far above the annual average.

New Brunswick's nurses will vote on whether or not they should go on strike next month. A proposed agreement failed to achieve ratification from the union's members, with 53% voting no.

After being fired last year from Toronto's Centre for Addiction Mental Health for sleeping with a patient, a nurse has had her licence revoked for taking part in the relationship. The nurse, who is not being named by the College of Nurses of Ontario, was let go by the hospital after the patient admitted to a manager that they had been sleeping together, and a sex tape was found. The patient killed himself earlier this year. His family is continuing the civil suit he filed against the nurse and the hospital.

"If you make it to 70 without gaining too much excess weight - apparently, it’s time to eat, drink and be merry - and don’t sweat the waistline," writes Dr Arya Sharma of a new study from Queen's University published in OBESITY. []

It's time again to celebrate "Bad Neuroscience Journalism Awareness Month" at Slate, with an evisceration of recent reporting by New York Times blogger Tara Parker-Pope.

The results of animal studies on THC, the psychoactive ingredient in marijuana, showed how the substance might actually improve memory if used in small amounts. So does that mean people should starting toking up to prevent the onset of dementia? "It's hard to say, no you shouldn't," said the study's author, psychology researcher Yannick Marchalant. "We still have a lot of work ahead to do in animals," he cautioned.

A really fantastic-looking exhibition on early X-ray images is currently on display at the San Francisco Museum of Modern Art. Check out the cool photos.

Next Tuesday Canadian Medicine will publish a new edition of Grand Rounds, a weekly collection of the best writing from health blogs.

If you wrote something you think I should include, or if you read a blog post elsewhere that warrants consideration, please email me at solomon at parkpub dot com. Submissions are due Monday, November 24 at 9am Eastern Standard Time.

Not familiar with Grand Rounds? Check out , at Dr Deb, or , at Musings of a Distractible Mind.

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

The physician who shared the 2005 Nobel Prize for medicine for his experiment in which he drank some Helicobacter pylori to prove it causes stomach ulcers, Dr Barry Marshall, was interviewed in the latest issue of the Canadian Journal of Gastroenterology. "If only I knew people would be so interested, I would have taken a photograph!" he told the journal editor and jazz drummer Dr Paul Adams. I wrote an article about other self-experimenters earlier this year.

Steven Lewis and Dr Penny Ballem hold a broad-ranging conversation on the current state of Canadian health policy, in the new issue of Healthcare Policy.

Healthcare Policy editor-in-chief Dr Brian Hutchison explains why some of corporate Canada may be anxious about expanding the role of private health insurance: employees and unions would come to expect the more expansive (and expensive) private insurance plans to be provided as employment benefits.

There are several interesting new articles in this week's Canadian Medical Association Journal. Around 30% of Canadians diagnosed with asthma don't really have the disease, one new study showed. [] The study's title says it is about the overdiagnosis of asthma, but the authors' conclusion and an accompanying editorial make clear that 30% of patients are simply being misdiagnosed, and their respiratory symptoms therefore not addressed correctly. Doctors are not making sufficient use of spirometry or pulmonary function testing, the editorial states. Far too many doctors simply give asthma drugs without confirming the diagnosis with objective tests. "This may be easy, but it may not be good medicine," the journal said. []

An estimate of the cost-effectiveness of Insite, the supervised injection clinic in Vancouver, found savings of up to $18 million over 10 years, largely from improved HIV and other infectious disease control. [] Though the authors call their estimate conservative, a commentary by a group of American specialists said that their numbers might be somewhat too high. Nevertheless, the American team agreed that Insite is indeed cost-effective. [] This research contradicts a substantial portion of the argument that the former health minister, Tony Clement, and other critics of Insite have been making for years. It doesn't sound as though our new health minister, Leona Aglukkaq, will change the valence of the government's position on Insite; a spokesperson told the Canadian Press yesterday, "There are better ways to help drug addicts."

There are signs of some tension once again between the Canadian Medical Association leadership and the association journal, the CMAJ. Dr Robert Ouellet wrote a letter, published in today's edition, emphasizing "quite clearly" that one of the journal's recent editorials expressed opinions that are "definitely not those of the Canadian Medical Association." [] The editorial in question was a criticism of the way the Conservative government handled the listeriosis outbreak and the calls for an inquiry. The line that may have worried Dr Ouellet politically was: "The listeriosis epidemic is a timely reminder that the Harper government has reversed much of the progress that previous governments made on governing for public health." [] Of all the editorial board members responsible for writing the piece, Dr Ouellet's letter named only Amir Attaran, the Ottawa professor and human rights lawyer who has been one of the most vocal critics of the Canadian government's treatment of detainees and failure to repatriate American Guantanamo Bay prisoner Omar Khadr. Is the CMAJ's advocacy politically troublesome to Dr Ouellet and his healthcare reform efforts? It seems that may be the case.

Dr Ernie Murakami told CBC News the BC College of Physicians and Surgeons initiated an investigation to try to push him into retiring because it disagreed with his methods of estimating the prevalence of and treating Lyme disease. He left practice this year because the investigation was "affecting his health," CBC reported.

A former New Brunswick doctor must pay the provincial government over $36,000 in fees he had overbilled. The judge ruled against Dr Wayne Howard's argument that the province could only collect the amount from his future earnings, instead of demanding he pay it back directly.

A US Department of Veterans Affairs research panel concluded that "Gulf War syndrome," long a point of contention between sick soldiers and government insurers, is indeed caused by chemical exposure during the war. But not the chemicals some had claimed: the researchers found that the illness was brought on by drugs given to soldiers by the US government to protect them from nerve gas, which commanders had feared the Iraqi military might employ.

The latest edition of the weekly bloggers' Grand Rounds is online today, featuring the best of the medical blogs.

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

Two more reports of pills mixed in to sealed boxes of kids' Halloween candies have police looking at where the candy -- all cases have involved by Smarties -- was manufactured.

Senior Canadian health policy analyst Michael Decter called Health Minister Leona Aglukkaq's job "a daunting task." "There is one central reason for our poor ratings, and it is not public medicare or long wait times or not enough doctors or lack of funding. The single biggest reason for Canada's poor international ranking is the poor health and health care of our First Nation, Inuit and Metis citizens," he wrote. "What are the solutions that need to be pursued? Many of them are beyond the health-care system. Better education, employment and housing will contribute to an improvement in health status." One of the most effective policy moves Ms Aglukkaq could make, said Mr Decter, is to encourage the training of far more First Nations health professionals, who are more likely to stay and work in their native communities.

A major new report on Yukon's healthcare system recommended cost-saving measures including charging patients for medical travel, charging taxpayers a health premium and tightening restrictions on qualifying for pharmacare. [ (PDF)] Journalists peppered Premier Douglas Fentie with questions about the recommendations, reported the Whitehorse Star. "By no means do we intend to implement all of the recommendations," he repeated again and again. "If any one of you report that we’re going to implement all of the recommendations, that would mislead the public and would be irresponsible journalism." The government is now asking for public feedback on the report.

Nunavut's first and only premier since the creation of the territory's government in 1999 has been replaced. Paul Okalik lost a vote in the territorial legislature to Eva Aariak.

Dalhousie bioethics and philosophy professor Chris Kaposy published an essay on the methods by which access to abortion should be improved in Canada. His proposals include: provinces should require more hospitals and clinics to offer abortion services; abortion procedures should be taught to more medical students; more provinces should adopt laws restricting protests very close to abortion clinics; New Brunswick should throw out its policy not to fund abortions done in private clinics (Dr Henry Morgentaler is in the process of challenging that policy in court) and if it does not, the federal government should penalize the province via a reduction in health transfers for its violation of the Canada Health Act; provinces should ensure women have alternative options made available to them when a doctor refuses to refer for abortion services, or women should be permitted to bypass a primary care physician and simply self-refer to an abortion provider; doctors who mislead or refuse to provide any information about abortion should be sanctioned for malpractice and ethics violations.

QUEBEC ELECTION UPDATE: ADQ leader Mario Dumont took a strong stance in favour of allowing patients to use a private-sector doctor or clinic if wait times in the public system are too long, essentially echoing the recommendations of the Castonguay report. "Our system hasn't improved because all our leaders do is change the names of departments, or put more money into the same system. But adding money is simply doing more of something that does not work," he said. Liberal Premier Jean Charest was thrilled to learn that PQ leader Pauline Marois told the Gazette about the huge cuts to the health budget she made in the 1990s by paying doctors and nurses to retire, "[I]f I had to do it over, I would do it over." "Nobody for a second today believes that it was the right decision. We still today live with the consequences of the retirement packages of doctors, nurses and technicians," said Mr Charest. "[T]here are a lot of Quebecers who are falling off their chairs today on hearing Pauline Marois say that she has no regrets and would do it all again." Ms Marois, meanwhile, was busy in Sherbrooke promising to provide each and every Quebec resident with a family doctor. PQ candidate Réjean Hébert, a gerontologist and the dean of medicine at the University of Sherbrooke, said more investment is needed in home care. A new poll published on the weekend in La Presse showed Mr Charest with 42% of voters' support, probably just at the cusp of a majority. After seeing the numbers, Mr Dumont admitted that his campaign has been largely unsuccessful so far. [La Presse]

Perspectives infirmières, a Quebec nursing organization publication, has opted not to accept advertising from private healthcare businesses. "We want to demonstrate our support for a strong public healthcare system," the organization's president said. "It's not a business decision. We're hopig we'll have other advertisers." [La Presse]

Surprising news from the Conservative Party convention in Winnipeg: a vote on adopting a proposed policy that said "encourage the provinces and territories to further experiment with different means of delivering universal health care utilizing both the public and private health sectors," did not get enough support to pass. Stephen Fletcher, the ex-parliamentary secretary for health, came out against the motion, although he reportedly said, "This motion will bring fodder to our enemies when it’s not necessary." [] According to Dawg's Blawg, another speaker who spoke against the motion said, "Why feed the press this all-day sucker?" Not exactly the best way to dispel Canadians' fears of a hidden Conservative agenda to be enacted as soon as that elusive majority arrives. As a side note, I can't help but wondering what the rationale was for passing a policy that asked for the "removal of support for full gender equality, also equal pay for equal work." Strange happenings in Winnipeg. Dawg's Blawg explains the dissonance as a battle within the party between "the deformed vision of the base" and "the world of the pragmatists, the people who actually have to govern and get re-elected."

On the other side of the aisle, Dr Carolyn Bennett was appointed the Liberal Party's health critic. She had been public health critic in Stéphane Dion's last shadow cabinet, and she was the minister of state for public health in Paul Martin's government. Also of interest from the Liberals' announcement were the appointments of Dr Hedy Fry as Canadian Heritage critic, former health critic Ruby Dhalla as labour critic, and Dr Keith Martin as veterans affairs critic (a major step down in terms of publicity, it seems to me, from prior critic assignments in international development, health and foreign affairs). [ (PDF)]

Middle-aged and elderly patients perceive nurses as more professional if they wear white uniforms, a new study found. Kids and adults under 44 didn't make that connection, however.

The disparities in health between white patients and black patients are well documented in the literature. But what about the way minority-group doctors are treated?