Vardenafil HCl is the Fastest Acting ED Medication

It cannot be denied that most men with erectile dysfunction (ED) owe Viagra a ‘thanks’ because it was them who pioneered ED medications.  If not for them, there might be no ED medications today.  Of course, this does not mean you will need to stick to that brand forever because there are other and much better ED medications in the market today than that of V…ra.  Take for instance, vardenafil HCl.  This ED drug is considered to be the most effective there is and has even surpassed Viagra in terms of efficacy.

According to different surveys performed, Viagra only has an average of 84% efficacy, whereas vardenafil HCl dominates it with 86% percent.  While the 2% may not seem much, if you belong to that group, then it means a lot.  For this reason, a lot of previous Viagra users have switch ship and are now taking vardenafil HCl as their preferred ED treatment drug of choice.  They even claim that they now experience fewer side effects ever since they moved to using vardenafil HCl. Read more…

What's in the news: Nov. 28 -- FPs issue their report card

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, November 28.

At the Family Medicine Forum, in Toronto, the College of Family Physicians of Canada released its 2008 report card on family medicine in Canada. It's the kind of report card you might have tried to hide from your parents when you were a kid. ("Honest, mom. They forgot to give them out this year.") Health human resource planning: D. Promotion of primary care to medical students and residents: B. Conditions for family physicians in practice: C. [ (PDF)] []

Doctors have an important role to play in combating the Jack Bauer-inspired "glamorization" and increasing public acceptance of torture, wrote Dr Homer Drae Venters, of New York University, in an excellent and sharply argued new commentary in The Lancet. [ (PDF)]

Two of Quebec's largest unions plan to take the government to court to contest the relatively new practice of allowing private clinics to perform medically necessary procedures if they pay to be affiliated with a hospital. [La Presse]

Seventy percent of Canadians don't follow colorectal cancer screening guidelines. [ (PDF)]

Ontario's government is under fire because a number of hospitals are projected to run deficits this year. "The situation in the province is very, very serious," Progressive Conservative health critic Elizabeth Witmer said.

Canada is facing a very serious shortage of obstetricians and midwives. "It’s a bad time to have a baby in Canada," wrote Lianne George in Maclean's. []

A pair of Montreal researchers analyzed a number of public opinion polls on private healthcare and determined that the methodology is often flawed and the design often biased. But the polls nevertheless serve an important political purpose, they wrote in their article published online ahead of print in Health Policy. "[W]hatever the real public opinion might be -- if indeed there is any -- on proposals to reform Canada’s and Quebec’s healthcare systems, current poll results provide a useful window of opportunity to those who would like to reform the system through increased privatization of funding."

In light of the recent stock market crisis and the declining value of many retirees' RRSPs, the Canadian Medical Association has asked the government for a "temporary moratorium" on regulations that force RRSP owners to start withdrawing money when they turn 71. Retired physicians, most of them having been private business owners and not government or institutional employees, do not collect pensions and therefore rely heavily on RRSP investments.

In covering a Johns Hopkins study on using CT scans to diagnose coronary blockages, the Baltimore Sun and the Wall Street Journal came up with vastly different headlines, wrote University of Minnesota health journalism professor Gary Schwitzer. "Hopkins study supports use of CT scan of heart," said the former, but "Heart scans sometimes fail to identify blockages, study finds," the latter warned. "Which headline tells the story? he asks.

Medgadget announced the winners of its 2008 medical science-fiction writing contest. Their stories have been made available to read online or download and print.

Voting for the first round of the 2008 Canadian Blog Awards closes mid-day on Saturday.

Though new Parliament not yet down to work, rumours emerge of government's imminent fall

With Parliament only just last week returning to business after the October election nullified most of our representatives' days in the House of Commons for this fall session, there is pressure to get things going in government as quickly as possible. That means new committee memberships will have to be named in short order. (Aside from the procedural committees, none of the others -- including the crucial Standing Committee on Health -- have been formed yet.)

But perhaps the committees won't even get a chance to sit. On Thursday, Finance Minister Jim Flaherty announced -- largely focusing on selling government assets and cutting government spending, including a provision to halt public funding of political parties, which the opposition parties say would bankrupt them -- that were immediately denounced by the Liberals, New Democrats and Bloc Québécois. It remains to be seen whether they will all hold their ground and really vote against the legislation on Monday, which would cause Stephen Harper's Conservative government to fall, or if Mr Harper and Mr Flaherty will back down and revise the plan to meet the opposition's approval, or, a third possibility, that this is all a game of political brinkmanship -- playing chicken with the oncoming train -- that the opposition will abandon when Monday arrives.

The prospect of the government falling has served as fuel for the latest rumour out of the easily ignited Ottawa rumour mill: that some people in high places in the opposition are discussing the possibility of avoiding another election by forming a coalition to replace Mr Harper's government. Former Liberal PM Jean Chrétien and former NDP leader Ed Broadbent met on Thursday to talk about the idea. The Liberals to replace Stéphane Dion as leader quickly, reported The Globe and Mail, rather than waiting months for their leadership convention in Vancouver to take place, if a coalition is to be formed.

But if the coalition talks fall through, this government will need to figure out a way to pass necessary legislation. So who can we expect to see in the Standing Committee on Health? Of , three Liberal members failed to win reelection in their ridings last month: former health critic Robert Thibault, former science and research critic Susan Kadis, and Lui Temelkovski. That leaves the new Liberal health critic, Dr Carolyn Bennett, the only Grit in caucus who served on the committee during Parliament's last session. She seems a logical choice to fill Mr Temelkovski's vacated committee vice-chair position, which according to parliamentary procedure must be filled by a member of the official opposition. The committee's four Conservative members, including committee chair Joy Smith, were all reelected; so too were NDP firebrand Judy Wasylycia-Leis and the two Bloc Québécois members. The upshot of all this is that the Health committee will look quite different this parliamentary session after all the Liberals lost so many seats. However, if Dr Bennett does indeed take on the committee vice-chair spot, the Conservatives may face an even more critical committee than they did last session, when Dr Bennett joined Mr Thibault, Ms Wasylycia-Leis and Ms Gagnon as the most vocal committee members.

Whether the government falls or survives, one thing is guaranteed: the respectful, polite House of Commons we were promised in the days following the October election was nothing more than wishful thinking.

Update, 12:01 pm: Apparently cowed by the Chrétien-Broadbent news, Mr Flaherty he will drop the controversial item about party financing from the bill to be voted on Monday.

Update, 5:10 pm: So much for the Conservatives' small compromise. It sounds that a Liberal-NDP-Bloc coalition could actually come to power, perhaps installing Stéphane Dion as Canada's temporary Prime Minister.

Photo: Parliament of Canada

What's in the news: Nov. 27 -- Money matters

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, November 27.

Dr Yvonne Vasilie, a Montreal obstetrician, has been reprimanded by her hospital for refusing to hand over a newborn's birth registration documents to the parents because they didn't have enough money to pay her fees. The mother, a Mexican woman, does not have Quebec health insurance and was therefore being charged directly by the doctor for her care. That's perfectly legal and normal -- but refusing to hand over important legal documents is neither of those things. "Her comments were inappropriate," the father said. "She asked me if I think that all immigrants that get off the plane and come to this country to have a baby don't have to pay." The papers were released after the parents complained to Lakeshore General Hospital and the Montreal Gazette began making calls. "There are ways for doctors to get paid, and that is not one of them," the hospital's chief of obstetrics told the Gazette. "Somebody that has absolutely no right to be in this country comes and then our government has to pay for it. Do you understand?" said Dr Vasilie. The Gazette's Charlie Fidelman paired that story with a report on the large increase over the past four years in debts owed by patients to Quebec hospitals.

Dr Luc Comtois, a family physician in Rock Forest, Quebec, has done away with his clinic's legally (very) questionable policy of charging patients $15 in order to be seen faster. []

Alberta Health Minister Ron Liepert's appointments to the new, consolidated provincial health governance board have stirred up controversy. Several are not Alberta residents, a number have no public health experience, and the man in charge of selecting candidates was Mr Liepert's campaign manager.

Dalhousie University may stop sending its emergency medicine residents to Saint John Regional Hospital, in New Brunswick, because the acting department head there and several other occasional emergency department staffers are not trained in emergency medicine -- a requirement for teaching-hospital accreditation. "Gone are the days when anyone with an MD who wants to, can be held as an emergency physician," Dr Mary-Lynn Watson, the director of the Dalhousie training program, told the Saint John Telegraph-Journal. "You don't have people doing cardiology who are not cardiologists, or people doing surgery who are not surgeons." Dr John Dornan, the acting department head, agreed, "They're right, I shouldn't be here." But it's easier said than done to just find some extra emergency physicians kicking around to fill in, the newspaper pointed out.

The majority of Quebec family physicians say they aren't sufficiently trained to handle front-line psychiatric care -- and that is exactly what is being asked of them much of the time. I wrote about recent provincial mental health reforms last year, when GPs and psychiatrists were both concerned about the government's idea of moving mental illness care out of the large hospitals and into communities.

The Globe and Mail's public health columnist, André Picard, praised Nunavut's forward-thinking public health strategy instituted by the new federal health minister, Leona Aglukkaq, when she was health minister of the territory. "It's not enough to have a $172-billion-a-year repair shop; we need to invest in creating healthy populations and do so with specific goals and targets in mind," he wrote. "We need to bring a little bit of Nunavut to the rest of Canada."

After days of harsh criticism from across Canada, the Carleton University Students' Association has apologized and decided to reverse its Monday decision to withdraw support from a cystic fibrosis fundraiser because of the mistaken belief the disease only affects white people.

Dr Martina Scholtens, trying to explain to a patient through an interpreter that she'll need to remove her clothes for a full physical, got lost in translation. It's a good thing she has a sense of humour.

In Quebec's frigid north, a group of doctors savoured some Chinese food next to a giant, stuffed polar bear. I kid you not. Dr Braam de Klerk has the photos.

"All but one of the family doctors here are women," the Canadian physician recruiter said. "In fact, most of the physicians in this community are women. It's okay though... male physicians don't work hard anymore either."

What's in the news: Nov. 26 -- QC sees rise in STDs and campaign rhetoric

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

QUEBEC ELECTION UPDATE: The Montreal Gazette's Hubert Bauch wasn't terribly impressed by the discussion of healthcare in Tuesday night's debate. "On health, which Quebecers tend to cite as the issue of greatest concern in this election," he wrote, "[Parti Québécois leader Pauline] Marois and [Liberal Premier Jean] Charest sparred over who had done the most harm to the system while in power, with Charest citing the cuts to health budgets and mass buyouts of doctors and nurses under the PQ and Marois accusing the premier of failing to keep his election promise of five years ago to repair the system and dramatically cut waiting times." The ADQ's leader, Mario Dumont, was criticized by his two opponents for his support of greater private-sector participation in the public healthcare system.

A law firm has launched a class action suit against the governments of Canada, Alberta and Saskatchewan and some regional health authorities over the syringe-sharing scandals recently unearthed in several medical clinics and hospitals. "Cockroaches come in groups," the lawyer Tony Merchant told the Saskatoon StarPhoenix. "If these mistakes are known to have happened in Alberta, Winnipeg, and the five districts in Saskatchewan... my worry for the nation is that it could be happening across the country."

Chlamydia, gonorrhea and syphilis are all becoming more common among Quebec youth, a new government public health study found. Some people claim the government's decision to move sex education in schools to an integrated model, without a dedicated teacher, is responsible, but a Ministry of Health official said the rise can be explained by better and wider testing.

Carleton University's student government voted to cancel an annual campaign to fundraise for the Canadian Cystic Fibrosis Foundation after a student claimed -- incorrectly -- that CF affects only white people and mostly men. In fact, CF affects both genders roughly at the same rate, and is found mostly in people with Caucausian backgrounds, which means that it is most common in whites as well as Israelis, Arabs and South Asians. The motion to withdraw the student government's support from the fundraiser, which was moved, ironically, by the science faculty representative, passed by a vote of 17 to two on Monday. [] The story elicited a particularly snarky editorial from the National Post. "Even by the loopy standards of students governments, this has got to be a new low... Members of the Students' Association at Carleton University have disgraced themselves and their school."

Dr Bonita Porter, the chief coroner of Ontario, was named one of Canada's top 100 women by the Women's Executive Network this year. "I refer back to something my mother said to me at a young age, that it's okay to question someone in authority if you have a sense that something is not right," she told The Globe and Mail.

New Brunswick union members held a protest outside the legislative assembly, accompanied by the leader of the provincial NDP, to express their displeasure with what they call the increasing privatization of the province's healthcare system with talk of the implementation of new public-private partnerships.

Steven Fletcher, a Conservative MP from Manitoba and minister of state for democratic reform, is appealing to the Supreme Court of Canada to get permission to sue the government of Manitoba for limiting his disability compensation to $3,000 a month. Mr Fletcher was paralyzed from the neck down when his car hit a moose 12 years ago. A new book released in September, What Do You Do If You Don't Die?, by Linda McIntosh, tells the story of Mr Fletcher's accident and subsequent entry into politics.

Colin Son interviewed me for Medscape. We talked about Canadian and American health policy, blogging and Parkhurst's new web ventures.

The deadline to nominate physicians for the Canadian Medical Association's 2009 awards is November 30.

Montreal group demands safe-injection site

Montreal homelessness advocacy network RAPSIM is leading an initiative to pressure the Quebec government to establish a safe-injection site in the city similar to the controversial Insite clinic in downtown Vancouver (pictured right).

"The benefits of supervised, safe injection sites are innumerable," the organization's Nicole McNeil . The sites, she said, "do worlds of good so far as harm reduction is concerned."

"After holding a press conference in August to ask the minister [Health Minister Yves Bolduc] to reconsider his decision not to provide supervised injection services and after writing to him about the same question, without receiving any response, it's now with a petition, the support of other groups and people that we hope our demand will be heard," Marjolaine Despars wrote in (Word document format) on behalf of RAPSIM earlier this month.

The group is now collecting signatures for its petition, which is available to be downloaded, filled out and mailed in.

Mr Bolduc announced in August that the Liberal government wouldn't create a safe injection site, despite a ruling from a British Columbia judge that found Vancouver's site to be constitutional. The previous health minister, Dr Philippe Couillard, a neurologist who has since left public service for a job with an investment firm, had that he was interested in starting an injection site.

In August, Mr Bolduc's decision to take a step back from Dr Couillard's enthusiasm prompted criticism from the Parti Québécois's Bernard Drainville. "This decision was made in ignorance, not by science or the facts," he . But the subject has not come up at all in the ongoing campaign for the December 8 provincial election.


What's in the news: Nov. 25 -- Vanishing cancers

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

Do some cancers simply vanish into thin air? That's what a new joint American-Norwegian study in the Archives of Internal Medicine claims to show, although some experts doubt the paper's conclusion that the natural course of some breast cancers is to "spontaneously regress." That means it could be harmful to aggressively treat some breast cancer patients rather than simply waiting to see if their tumours disappear, the Canadian Press reported.

There is a huge difference between the health of affluent urbanites and poor urbanites, a Canadian Institute for Health Information study showed. [] Efforts to remedy that inequality by addressing the underlying poverty have been insufficient, 18 of Canada's top urban public health physicians said. "We have understood for a long time that people with lower socio-economic status experience significantly worse health than those with higher socio-economic status. Yet the lives of far too many Canadians continue to be burdened by preventable poor health. This is not acceptable," said Montreal public health director Dr Richard Lessard in a statement. []

Many passengers who were potentially exposed to tuberculosis on flights to and from Canada were never contacted and warned of the risk of infection because the airlines didn't disclose the flights' passenger lists to Canadian public health officials, reported The Globe and Mail. The Liberal Party blames the Conservatives.

An interdisciplinary meeting on the effects of probiotics on the relationship between the brain and gut, held in Quebec City and sponsored by a probiotics company, came up with some really interesting ideas about probiotics' potential ability to relieve stress and anxiety and reduce psychiatric comorbidities associated with IBS. [] I'll wait until I see the data in a peer-reviewed journal to believe it, but the concepts raised about brain-gut interaction -- about which not a whole lot is known -- are fascinating.

Too few Canadians with osteoporosis receive bone mineral density testing, says a new Osteoporosis Canada report. Report cards on the rate of testing and on the public-insurance coverage of appropriate drugs found that most Canadian provinces fare poorly; some even received failing grades. []

Health blog award voting begins

Voting for round one of this year's Canadian Blog Awards is open until mid-day this Saturday, November 29. The main voting page is , and the "health blog" category voting page is .

Voting for the begins on December 8, 2008. The nomination period is now closed for the "medical/health issues blog" category.

Grand Rounds 5:10

Welcome to Grand Rounds, the weekly anthology of the best of the health blogs. (For those of you unfamiliar with Grand Rounds, which is hosted by a different health blog every week, you can read more about it .)

Bongi, a pseudonymous South African general surgeon, writes about a recent gunshot case he handled at an awful-sounding hospital (he refers to it simply as "hell") and the rather colourful language he had to resort to using to get the blood bank to cough up the amount of blood he asked for.

In a rough but refreshingly raw essay on personality and chronic illness, Leslie, a young woman with rheumatoid arthritis and lupus, describes her process of learning to accept her illness and come to grips with what it means for her life.

Yes, indeed showed that the statin Crestor was of clinical value to patients, Dr Rich thoughtfully writes. No argue otherwise, he says, is spurious. However, that doesn't mean everyone should take the very expensive statin. What's the rationale for not giving an apparently safe drug to patients who stand to benefit from it? "[T]here’s simply no good answer to this question as long as we insist on pretending that rationing is not necessary and is not already occurring." The solution, Dr Rich says, is to break the taboo and actually discuss healthcare rationing openly, honestly and rationally. Sandy Szwarc, however, isn't convinced that JUPITER is nearly as powerful a study as many people have claimed. She describes her many problems with the trial, including the decision to end the study early.

Ms Szwarc also tears apart the fawning media coverage of a recent abstract that was widely (and incorrectly, she says) reported to show that obese kids and kids with high cholesterol levels develop thick-walled carotid arteries, which could therefore put them at risk of serious cardiovascular problems. There were plenty of questions that no journalist asked and are crucial to understanding the claims made by the promoters of the research.

Doc Gurley came up with a fantastic idea for a new series on her blog, called "Well Worth It," a round-up of cheap and easy things you can do for your health that don't get enough attention. In the first entry, published last week, her simple treatments are: electric fans to prevent SIDS, old-fashioned treatments for IBS, and an inspirational article on quitting smoking.

American plastic surgeon Ramona reports on new evidence that breastfeeding does not, despite what many women believe, contribute to sagging or any decrease in the esthetic appearance of the breasts. It's an important point because there are women who might otherwise breastfeed who elect not to because of fears about their appearance. Despite its methodological limitations, Ramona hopes this study will dispel women's anxieties about breastfeeding's effect on their looks.

How to Cope with Pain looks at the drug methylnaltrexone bromide, marketed as Relistor, and approved earlier this year to relieve opioid-induced constipation and then .

Jolie Bookspan, who writes about back pain and fitness, answers a reader's question about how much "inward curve space" should exist at the lower back. Dean Moyer explains how twisting can cause a herniated disk, and what activities can eventually lead to a problem.

Dr Paul Auerbach writes about a recent presentation by the Colorado emergency physician "altitude medicine" specialist Peter H Hackett on how to treat acute mountain sickness and high altitude cerebral edema. Did you know 15-40% of skiers in Colorado develop acute mountain sickness? I sure didn't.

Neurology professor and researcher Joshua Steinerman is thinking about the value of routine cognitive screening. And he's looking for readers' input. In another post, Alvaro Fernandez interviews an expert on cognitive decline.

A pathology resident's friend wondered what pathologists actually do with surgical specimens. Here's the answer.

Don't miss the American College of Physicians ACP Internist blog's weekly "Medical news of the obvious" column. Recent entries include studies that found suntanners often get burned at the beach, that people hate waiting in line, and that media coverage affects people's perception of infectious disease threats. "As opposed to people just going out and conducting their own field research about all the infectious disease in the world," snickered Jessica Berthold.

Testifying in court against a patient who attacked her and three colleagues with a makeshift blade, this nurse urged the judge to sentence the attacker to jail time rather than a psychiatric hospital where he could talk his way out of being locked up for very long. "A lot of people have 'issues'," she writes in her compelling account of the day, "but they don’t try killing three old nurses, a pregnant nurse and her unborn child."

American readers already know that Thanksgiving -- that most holy of holidays, replete with blessed bird and sacred stuffing -- is this Thursday. (We Canadians already enjoyed our Thanksgiving well over a month ago. I had a bite of a turkey sandwich and a pickle.) Laurie Edwards, a writer and sufferer of celiac disease, writes about the challenge of trying to eat gluten-free at Thanksgiving dinner. (I have to admit that the Brussels sprout hash doesn't tempt me.) Jenni Prokopy compiled a list of eating advice for people with gluten problems and other food-related illnesses. Both Ms Edwards and Ms Prokopy recommend Gluten-Free Girl, who has provides recipes for celiac-safe versions of gravy, stuffing, chutney and pumpkin pie. I'd like to give thanks for the internet and all the dedicated altruists who share such great advice.

Med student Peter Zavislak recently performed his first surgery, in Afghanistan -- an excision of a Baker cyst. Things don't go exactly as planned. First, he tries cutting with the wrong side of the scalpel ("The curved side is blunt, the flat side is sharp. How counter-intuitive. Is this some sort of ritual hazing by surgeons?") but things turn out okay in the end. "See one. Do one. Teach one," he writes. "I skipped the first step. I'm not quite ready on that last one."

An odd story from Norway: A surgeon left a 20 cm sponge inside a patient. Then a radiologist saw the sponge in an X-ray... and didn't do anything about it. Finally, the sponge was found and removed. Multi-million malpractice suit, right? Wrong. The patient told a reporter, "Do I have confidence in the hospital after this? Yes, I do. To err is human." "Surgeons are not omnipotent deities," The Sterile Eye comments, in admiration of the patient's attitude.

Dr Drew Rosielle, from Milwaukee, travelled to Montreal this fall to take part in a conference on palliative care and produced this very thoughtful essay on the role of grief in medicine and his own feelings about his patients and his family. Walking through an exhibit of photos of palliative care patients, he found himself crying. He wrote, "[I]t may only be the last few years - getting older, kids, hundreds of patients dying a year - that I had something that needed catharsis, particularly as the stimulus to much of my grief is one that I have to repress/manage as it unfolds."

Nursing has become increasingly complex over the years but nursing education may not be doing enough to exposes nursing students to a variety of different care contexts they might face, emergency nurse Kim writes. "I can’t help but think that nursing students are missing out of many learning opportunities," she says, such as in a rural hospital, a major city hospital or a psych unit.

Amy Tenderich explains the origins of the plain blue circle as a symbol of World Diabetes Day. "The blue color is meant to evoke the color of the sky, and the circle is a symbol of unity," she writes. Unfortunately, most people -- including some from the American Diabetes Association -- seem not to have the faintest clue what the blue circle is all about.

Dr Dainius Drukteinis, who holds degrees in both medicine and law, discusses a 2007 New York malpractice suit in which an emergency physician was found negligent for failing to hurry his patient through an excessively long series of diagnostics, consults and referrals for his two severed fingers. Seven-plus hours of waiting before orthopedics gets on the case is "about the upper limit without trying to break records," one expert witness testified. "[W]hatever the systems failure or distraction, it must be remembered that it is the emergency medicine physician who is ultimately accountable for those delays in time," conlcudes Dr Drukteinis.

To bring malpractice claims under control, Duncan Cross writes, the costs that arise from medicine's inherent risks shouldn't fall to the injured patient. Instead, he writes, we should look for a solution that gives providers incentives to avoid medical errors (perhaps a touchy suggestion; do providers really need incentives to avoid screwing up?); distinguish better between illegitimate and legitimate claims of malpractice; and make the medical system's error rates more transparent.

The recently adopted American health information privacy law, HIPAA, was supposed to help patients. But Mexico Medical Student Enrico discovered -- in a frustrating way -- that the law can just as easily become a major roadblock in the way of patients trying to get access to their own records in some situations.

Dr Val Jones wonders what former Senate majority leader Tom Daschle's appointment as Barack Obama's secretary of health and human services will mean for the future of American healthcare. She complains that "equal access to nothing is nothing."

Massachusetts health lawyer David Harlow comments on the fast-approaching implementation of federal legislation on patient-safety organizations, intended to allow safe, confidential reporting by healthcare providers of medical errors and adverse events. "All in all," he writes, "this is a welcome step forward for the further development of evidence-based medicine, taking into account details of negative outcomes and using those outcomes as learning opportunities for the system as a whole without exposing individual providers to additional potential liabilities."

My contribution to this week's Grand Rounds is an article I wrote recently on doubt among the medical community about whether doctors' sex scandals should be made public or not. [Canadian Medicine]

One last article, which arrived in my email this morning: Toronto-based clinical psychologist and Red Cross volunteer Romeo Vitelli on AIDS in South Africa.

Also worth mentioning is a designed just for Grand Rounds, created by Marshall Kirkpatrick.

Grand Rounds will be edited next week by .

What's in the news: Nov. 24 -- Alberta's "problem child," Rockin' Ron

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

The government of Newfoundland and Labrador has rescinded its demand for physician employees to sign a confidentiality agreement that could have prevented them from speaking out publicly if they see a problem with patient safety. Doctors had been refusing to sign the document after the Newfoundland and Labrador Medical Association recommended they not do so. The contract has been been amended to reflect the medical community's responsibility to advocate on their patients' behalf.

A medevac airplane pilot is being praised for managing to crash-land and evacuate his plane without any casualties in northern Manitoba on Saturday, after the plane caught fire in mid-air. The pilot, the co-pilot, the toddler patient and the patient's mother, and nurse all escaped from the crashed plane before it exploded.

Alberta Health Minister Ron Liepert (or "Rockin' Ron" for short, in the Calgary Sun's opinion pages' inimitable shorthand) is in hot water for disclosing the name of a candidate who was not hired to serve on the province's new health administration board -- and with whom he just so happens to disagree politically: David Eggen, a former NDP representative and now the executive director of the anti-privatization Friends of Medicare organization. Mr Eggen has demanded an apology for Mr Liepert's decision to announce in the legislative assembly that Mr Eggen "was not among the best candidates." Typically, civil service applications are considered private. Mr Liepert is the Alberta legislature's "problem child," commented Paula Simons in the Edmonton Journal. "During question period, he leans and lounges in his chair, his body language telegraphing his boredom and impatience... As Alberta's health minister, he has a grown-up job to do. It's time for him to start doing it like a grown-up."

New Brunswick's centralization of its non-clinical hospital services -- such as laundry and IT -- is ramping up, and the health minister is already making very ambitious claims about projected savings.

More than half of Canadian HIV/AIDS patients report suffering depression as a result of their disease and say their illness makes finding work more difficult, and 82% report that a serious stigma still accompanies their HIV-positive status, according to a new survey of Canadian patients called "HIV+25." []

A massive WHO program to prevent the spread of lymphatic filariasis, in collaboration with GlaxoSmithKline, Merck, the Gates Foundation and various governments, will provide antiparasitic medicine to 500 million people this year. A new report of the success and cost-effectiveness of the initiative, which prevented 6.6 million cases of the disease in just seven years between 2000 and 2007, is good news in the ongoing effort to entirely eliminate the disease.

PEI's health minister was surprised to learn that his department has a policy in place that forces patients to pay for ambulance transfers between hospitals for testing if the trip involves an overnight stay. [] Embarrassing news for Doug Currie, the health minister, but that was undeniably some great reporting by The Guardian.

A Quebec court is set to hear an assisted-suicide case that could set precedent. A 30-year-old man, Stephen Dufour, is charged with helping his uncle, who suffered from polio, hang himself. His uncle had tried to commit suicide before. If the verdict comes down as guilty, Mr Dufour could be jailed for up to 14 years.

A University of Guelph study on rats suggested that methadone may help treat cocaine addiction, not just heroin addiction.

What is life like for med students contemplating becoming abortion providers?

In Africa, rats are being trained to detect tuberculosis and land mines, just using their noses.

After a heated argument about wait times and proper decorum with an opposition MLA in the legislature the previous day, Nova Scotia Health Minister Chris D'Entremont arrived at his office on Friday morning and wasn't too pleased about what he found. "They put a baby bottle and a soother on my desk," he told the Halifax Chronicle-Herald. I am trying to keep [debate] at a higher level. They are trying to keep it at a lower level." According to the newspaper, Mr D'Entremont first suspected the man he argued with of committing the foul deed, but later accused another Liberal of doing it. They both denied any involvement in the heinous crime.