Canadian Medicine

"Ooh La La"

They'll trap you, then they use you
Before you even know,
For love is blind and you're far too kind,
Don't ever let it show.

I wish that I knew what I know now
When I was younger.
I wish that I knew what I know now
When I was stronger.

Back in 1973, Ronnie Wood, of the Faces, was singing about women and the way life turned out in that track "Ooh La La" but you'd be forgiven if you thought he was describing the way British Columbia doctors now seem to feel about their patients and their profession.

A third of British Columbia family physicians said they would have chosen a different career if they had known the hassles and headaches they'd face as doctors, according to a new poll. [ (PDF)]

"[I]t should be a rewarding career, but there are certain hassles every day that make some doctors feel crummy at the end of the day like the huge volume of messages, the stacks of e-mail and faxes, that greet them every morning when the waiting room is already full of patients," BC Medical Association president Dr Bill Mackie said. Stress is a problem, said Dr Mackie. "[T]he consequences of a misstep such as a misdiagnosis can be frightening, if not horrifying." He added, "Patients can be unreasonably demanding. It's nice when they show appreciation for good care."

Got a hankering to hear the tune now? Check out this rendition by a handful of Canadian musicians:


A leaking ship?
Several leaks at the Chalk River nuclear reactor facility in December expelled tritium into the air and radioactive water directly into the Ottawa River. The incident only came to light because Sun Media got a copy of an internal safety commission report.

Green Party communications director John Bennett accused the nuclear safety officials of being reluctant to order the facility shutdown because that would halt the production of medical imaging radioisotopes. "Of course, is the nuclear safety commission going to shut down that reactor for safety after what happened a year ago? The people responsible for safety are afraid to shut it down because the last time they held up production, their president got fired."

Even the Prime Minister's Office was not informed of the leaks. "Whatever happened," the Toronto Sun wrote in an editorial, "all of us have a right to know when there's a radiation leak at a reactor, no matter how 'safe.'"

By sheer coincidence, Nature today published an essay by BC Cancer Agency researcher Thomas Ruth about the need to develop a new way to produce medical isotopes in order to avoid the uncertainty of relying on a single, apparently unreliable, nuclear reactor. "Shockingly, there are no clear plans in place for how to tackle this problem. My colleagues and I see viable mid-term and long-term solutions. Each relies on a very different plan. But both involve accelerators, rather than reactors."

Burned by the budget
When the Conservative government presented its budget on Tuesday, Genome Canada, an independent research organization, saw its annual government funding drop from $140 million to zero. "We got nothing, nothing, and we don't know why," Genome Canada president and CEO Martin Godbout, who was described as "stunned" told The Globe and Mail. "We're devastated." [] Kady O'Malley speculated that the government may have simply forgotten to include Genome Canada in the budget. []

An Aussie in Alberta
An Australian was named head of the Alberta Health Services board. Stephen Duckett is already somewhat known in Canada for writing a Canadian Medical Association Journal article in 2005 warning against privatization. [] "Public funding of health services is a core principle of medicare and that, as far as I'm concerned, is not on the agenda," he told the Edmonton Journal.

Agent Orange fight lingers
Some New Brunswickers are upset that their claims for compensation for exposure to Agent Orange have not been approved.

Doc donates a kidney
Dr Naeem Bhojani, a Montreal urology resident, donated a kidney to save his mother, who is in hospital with an autoimmune disease.

Good news for Dr Bhojani: A new American study in NEJM found that kidney donors live just as long and as just as healthy lives as non-donors.

"Facebook for doctors"
, the Canadian Medical Association's Facebookish social networking website, has rapidly gained in popularity since it was launched in August, with nearly 1,300 doctors registered.

So much for long-term planning
The Health Council Canada will release a report tomorrow blasting Canadian governments for failing to create a national pharmaceutical strategy, which was promised in the 10-year Health Accord signed by the federal government and the provinces in 2004.

Questionable findings
Does masturbation cause prostate cancer? Dr Amy Tuteur investigates.

Dr Kevin Patterson (right) has admitted to acting unethically and unprofessionally and has been disciplined by the College of Physicians and Surgeons of British Columbia for publishing a graphic magazine article about his experience treating soldiers in Afghanistan.

In , published in Mother Jones magazine, Dr Patterson vividly described and gave the name of a Canadian soldier who died in a shooting that took place inside NATO's Kandahar base.

The Canadian military, which was investigating the killing and has since laid charges against another soldier, for releasing classified information without permission but .

The (PDF) from the College of Physicians and Surgeons of BC consists of a written reprimand and requires Dr Patterson to take courses in ethics and professionalism, to pay $5,000 in costs to the college, and to donate the $7,000 Mother Jones paid him for the article to charity. The punishment has been publicized across the country, from Dr Patterson's local to and . "I'm glad he did admit it," Kevin Megeney's mother told CBC News. "We were shocked at the article. It was very graphic."

Dr Patterson's admission that he acted unethically stands somewhat in contrast to a statement he made to me shortly after the article appeared in print in summer 2007, when he seemed to defend his decision to publish the soldier's name and to describe his dying moments in detail. "If the public is to get a sense of the price being paid on our behalf by these young men and women, it is necessary to face with open eyes the grotesque nature of war trauma," he wrote to me . "The recent disengagement and fatigue of the public with these matters is itself grotesque."

As a journalist, Dr Patterson acted not just ethically but admirably. But as a physician -- as the College argued, and as he seems now to admit -- his ethical obligations changed. Could Dr Patterson's admission cause a chilling effect in his and other physicians' writing and reporting? I hope not. Dr Patterson and other doctors will surely realize that the circumstances that led to this outcome were unusual and limited in scope. Nevertheless, in the disciplinary decision is a good lesson for doctors who write: "Dr. Patterson has assured the College that in any future writings based on medical scenarios, or in any future works of journalism or fiction, he will not include the identities of patients or any information that could identify patients."

Also, let me add: don't breach the terms of your confidentiality contract with your employer.

A new lawsuit claims British Columbia's Medicare Protection Act is unconstitutional because it denies patients the right to seek medical care in the private sector if they so choose, the Vancouver Sun.

The plaintiffs in the case are the Canadian Medical Association's outspoken past-president and owner of the larger private Cambie Surgery Centre in Vancouver, Dr Brian Day (right); the False Creek Surgical Centre's Anna Stylianides; and Canadian Independent Medical Clinics Association president Zoltan Nagy.

The Sun's Pamela Fayerman and Catherine Rolfsen wrote:

"The plaintiffs will argue that the 2005 Chaoulli Supreme Court of Canada case should be applicable in B.C. In that case -- brought by appellants Jacques Chaoulli, a doctor, and George Zeliotis, a patient -- the highest court struck down Quebec's ban on private insurance for medically necessary services. The private clinics are expected to argue that citizens should be allowed to buy private health insurance to use in private clinics if their operative care is not delivered in a timely manner in the public system."

More details should emerge after today's press conference. Canadian Medicine will keep you posted.

Update, Thursday, January 29: Read accounts of the press conference and the reactions of Liberal Health Minister George Abbott and NDP health critic Adrian Dix, in the , the , , and .


FURTHER READING

• Check out what readers are saying about the news on the Vancouver Sun's .
• Read my 2007 article "" from the National Review of Medicine, about the effects of the Chaoulli decision beyond the borders of Quebec.
• I also wrote about an similar to this BC case.
• In August, as Dr Day ended his term as CMA president, Canadian Medicine asked, "Was Dr Brian Day's CMA presidency a success or a failure?"
  

In the brief span of time that's passed since Finance Minister Jim Flaherty (above) presented the federal government's , it's hard to find someone who hasn't weighed in with their opinion.

We know now, of course, that the budget will be passed in the House of Commons. (Liberal leader Michael Ignatieff, who spent Tuesday evening reading the document before announcing his party would support it with a minor amendment, was among the last people to toss in his two cents on the hotly anticipated budget. Jack Layton, perhaps the first, formed his opinion of it before it was even created.)

What the budget will mean for healthcare? First of all, take a gander at Liberal health critic Dr Carolyn Bennett's summary of what the budget includes with regard to healthcare. The most important two items are: $500 million in new funding for Canada Health Infoway for electronic medical records, and no change to the 6%-per-year increase in federal health transfers.

So what is everyone saying about the budget's healthcare promises?

: "Today's announcement, rightly aimed at supporting the front lines of health care, will lead to better, more efficient care and will help Canada shake off its laggard status in terms of the use of EMRs compared to other countries."

: "The Government of Canada's continued financial support means every province and territory will continue to benefit from the improved patient safety, cost savings and increased clinical efficiencies that electronic health record systems generate... In addition, thousands of sustainable jobs will continue to be created throughout Canada's health and information technology industries as a result of the government's investment."

: "The implementation of information technology and electronic health records is critical to enabling health system integration... Inclusion of home and community care in the electronic health record is essential to providing safe and effective care and supporting individuals to live independently in their own homes"

: "The 2009 federal budget ignores the child care needs of Canadians trying to hold onto jobs and retrain... When you have lost your job and can no longer afford child care to study or look for work, how is a tax cut going to help you? From the United Nations to the OECD, Canada has been repeatedly chastised for its failed child care policies and their impact on women's equality and healthy child development. And now, it's more of the same."

: "Investments in Canada Health Infoway can have a 'powerful' and 'transformative' impact on the health system", said Dr. Jack Kitts, Chair of ACAHO, and President and CEO of The Ottawa Hospital. "Furthermore, building world-class research infrastructure through CFI will continue to position Canada to reap the many benefits of leading-edge knowledge that is created and owned by Canadians." That said, separate from the temporary expansion of the Canada Graduate Scholarship Program, there are concerns about the lack of additional base funding for the Canadian Institutes of Health Research, Genome Canada and funding to cover the indirect costs of research.

: The professional association that speaks out for registered nurses in Ontario says the federal budget deserves marks for spending on infrastructure projects, social housing and modest measures to help low income families but misses a prime opportunity to build Canada's health infrastructure by ensuring an adequate supply of nurses and other health providers to care for Canadians.

What do you think? Without mentions of poverty relief, a national pharmaceutical strategy, health human resources or a significant environmental program pegged to infrastructure renewal, is the 2009 budget healthy?

Hetero-normative healthcare
A Winnipeg lesbian couple filed two complaints against an Egyptian-trained family doctor whom they claim refused to take them on as patients because she had never treated "people like you." One complaint was filed with the province's human rights commission, and the other with the College of Physicians and Surgeons of Manitoba.

The doctor, Kamelia Elias, however, disputes the couple's version of events. "They get a lot of diseases and infections," she told the Winnipeg Free Press. "I didn't refuse to treat them, I said it's better to find someone who has experience and will take this type of patients. There (are) some doctors who can treat them." But one of the women, Andrea Markowski, maintained, "She said, first thing, that it was against her religion, and second, that she had no experience caring for lesbian or gay patients."

The director of the medical clinic backed up Dr Elias: "[She] at no time refused to accept these women into her practice... Dr. Elias felt it necessary to be up­front with regards to her own religious beliefs and inexperience in treating homosexual patients,” said Dr Terry Gwozdecki.

Brain wave
The electronics corporation LG issued a on its LG 150 cell phone model, citing a claim that the phone may potentially pose a health threat. Officially, the LG 150 phone is no longer certified under Radio Standards Specifications 102 (RSS 102), Radio Frequency Exposure Compliance of Radiocommunication Apparatus.

In plain English, that means the phone was found to emit more radio-frequency energy than is allowed by law. A Bell Canada spokesperson told The Globe and Mail this is the first time a cell phone has lost certification for exceeding energy emission regulations.

Parliament gets down to work
The House of Commons Standing Committee on Health finally has some members, about two and a half months after the November federal election. The delay in naming members to nearly all the committees was a result of the Governor General's decision in early December to prorogue Parliament. According to yesterday's announcement, Health Committee members will include six Conservatives (Patrick Brown, Colin Carrie, Patricia Davidson, Cathy McLeod, Joy Smith, and Tim Uppal), three Liberals (health critic Carolyn Bennett, Kirsty Duncan, Joyce Murray), two Bloc Québécois members (Nicolas Dufour, health critic Luc Malo), and one NDP member (health critic Judy Wasylycia-Leis). In November I speculated that Dr Bennett will be given the vice-chair post. [Canadian Medicine]

Depression and allergies linked?
Having depression may increase the likelihood of also having non-food allergies, the suggested results of a relatively weak but fascinating new Canadian study. A team of four researchers from the University of Calgary's Department of Community Health Sciences, including one of Canada's top depression researchers, psychiatric epidemiologist Scott Patten, found that people with depression were 20% more likely to suffer from allergies, though that calculation failed to reach statistical significance. They theorized that the reason for the possible connection may be an increased immune system activity in depressed people, or it could be that something else entirely predisposes people both to depression and allergies. Oddly, smoking protected against developing non-food allergies. [ (PDF)] Some background on the connections between depression, immune system function and allergies is available on Dr Patten's blog. I interviewed Dr Patten for an article in the January issue of Parkhurst Exchange about his thoughts on the future of depression diagnosis and treatment in Canada.

Tattoo and piercing blood-donor rules may be useless
Until a few years ago, Canadian blood donors were asked to wait at least 12 months after getting a piercing or tattoo before they could donate. In August 2005, Canadian Blood Services revised that to six months. (Héma-Québec, which administers the blood donation program in Quebec, followed suit two months later.) A study published online earlier this month in Transfusion by a University of Ottawa team affiliated with Canadian Blood Services analyzed the effect of that decision on the safety of the blood supply. The result: there was no effect. Shortening what is referred to as the deferral period did not make the blood any less safe. Having a tattoo at all meant that hepatitis C risk was raised, but recent tattooing and piercing made no difference on hepatitis C or B prevalence. The authors concluded, "There was no measurable adverse effect on safety and a positive but less than expected effect on blood availability after shortening the deferral period for tattoo and piercing. The length of other temporary deferrals should be reassessed, since their current contribution to blood safety may be negligible."

Concussions' lingering after-effects
Retired hockey and football players can suffer lasting neurological effects from a concussion -- including memory problems and motor function -- even if their last concussion happened as much as 30 years ago, a University of Montreal study found. [ (PDF)]

Abortion access still an issue
Vicki Saporta, CEO of the US-based National Abortion Federation, commemorates the 21st anniversary of the Morgentaler decision today with an op/ed in the Toronto Star about what in some parts of the country remains limited access to abortion services. "The battle for abortion rights was fought in Parliament, in the courtroom and in the streets. These efforts were successful and today Canada is one of only a few countries without a federal law restricting abortion. However, challenges to accessing abortion care in Canada still exist. Even though abortion is considered a safe, legal and insured service, access is variable across the country."

An ethical conundrum
Rheumination, after learning of a US warning about Lyrica's increased suicidal behaviour risk, has a great question about medical ethics. Given that the US Food and Drug Administration often releases major drug warnings ahead of Health Canada (as is true in the case of Lyrica), should Canadian doctors keep up with FDA warnings too? "But if this is the case," wrote Rheumination, "am I, as a Canadian, obliged to keep up with all the wisdom arising from below the 49th and treat it as my own? And the Europeans aren't exactly slouches over there. Must I keep abreast of all things brewing at the European Medicines Agency, or the UK's NICE. Should I learn how to speak Australian. so I can get info from the Australian TGA. Maybe so."

Vancouver lecture
Dr Marcia Angell, the former editor of the New England Journal of Medicine, will give a free lecture in Vancouver on February 21. [] Her most recent article, a review of three new books on doctors and the pharmaceutical industry, appeared in the New York Review of Books. In October, she wrote an essay in the Canadian Medical Association Journal warning Canada not to imitate the American healthcare model. "Privatizing Canada's health care system, even a little, will inevitably cause costs to rise and access to decline," she wrote. "The wisest course for Canada is to expand and reinforce the public system, not undermine it." []

Where drugs go when you flush
The St. Lawrence River contains all sorts of potentially toxic pharmaceutical products, including bezafibrate, enalapril, and chemotherapy drugs methotrexate and cyclophosphamide, reported University of Montreal researchers in a new study on a novel rapid detection model they are using, in the Journal of Environmental Monitoring. []

Montreal's sewage treatment facility appeared to significantly reduce the concentrations of bezafibrate and enalapril, and may have entirely eliminated the presence of the chemo medications. "All in all, these quantities are minimal, yet we don't yet know their effects on the fauna and flora of the St. Lawrence," said environmental chemistry professor Sébastien Sauvé. "It is possible that some species are sensitive to them. Other ecotoxicological studies will be necessary. As for the chemotherapy products detected in the raw wastewater but not in the treated wastewater, one question remains: did we not detect them because the treatment process succeeded in eliminating them or because our detection method is not yet sophisticated enough to detect them?"

Sierra Club campaigner Maureen Reilly, the editor of the Sludge Watch newsletter, commented, "I think it has to be said that sewage treatment plants are 19th century technology trying to deal with 21st century pollutants."

QC, NB, NS struggle with wait times
Faced with complaints from angry patients, Michael Murphy, the health minister of New Brunswick, said he could sympathize: he was among the patients who had to be treated in the hallways of the province's overcrowded hospitals. "It's very unfortunate, but [patients] are being well cared for," he told a Moncton man who was attended to in the hall. "It's inconvenient for the staff and it doesn't lead to a very nice functioning of a hospital." The exchange came during Mr Murphy's announcement of a $73-million expansion to the Dr Georges-L. Dumont Regional Hospital, in Moncton. []

Quebec Health Minister Dr Yves Bolduc admitted that eliminating emergency-department wait times longer than 48 hours is not feasible, despite an earlier claim by his own director of emergency wait times that that would be the goal over the coming year. Instead, Dr Bolduc said, Quebec would aim to reduce the average emergency wait time from 16.7 hours to 12 hours. ADQ health critic Éric Caire pointed out that the 16.7 figure is actually higher than the average wait time was last year. [La Presse]

Halifax health officials said that the director of the Queen Elizabeth II emergency department didn't have to call a "mass casualty" "code orange" alarm last week, but Dr John Ross defended his decision, saying he had been left with no other choice but to call for immediate relief under the circumstances. The back-up at the QEII emergency department caused a "ripple effect" of delays in other clinics and hospitals in nearby towns, reported the Chronicle-Herald.

Nurses vs. physician assistants
The Registered Nurses Association of Ontario (RNAO) said that it opposes Ontario's move to increase the number of physician assistants in the province. The RNAO would prefer to see more nurse practitioners trained and hired. RNAO executive director Doris Grinspun said allowing physician assistants to do surgeries may be dangerous. "I would say to my family, friends, colleagues, to the public: don't let them touch you."

Offshoring your MRIs
An unnamed Ontario clinic is outsourcing its radiology consults to Telediagnosys, in Pune, India, reported the National Post. "Their earlier radiologist used to take at least 48 hours to give the reports and charged more than us," said Telediagnosys chief operating officer Dr Ashish Dhawad. Outsourcing medical care overseas, the article said, raises serious issues about jurisdictional oversight and liability.

The newspaper's editorial board chimed in with its opinion: in short, don't get all worked up about this. "We need to stop worrying about such tangential issues as whether our blood tests are being read in Mumbai or Medicine Hat, and start looking for solutions — private as well as public — that will give the greatest number of Canadians the best care as quickly as possible."

Meanwhile, in India, the minister for overseas Indian affairs said that the government is considering granting permission to Indian physicians who practise overseas to return to India with a license to practise. The Canadian Association of Physicians of Indian Heritage claimed that one in 10 doctors in Canada and the United States are of Indian-subcontinent origin. The government may provide "assistance" -- presumably financial incentives -- to lure doctors back to India.

In the literature...

Warm showers may increase your risk of developing cancer. Trihalomethanes (THMs), which are a type of "disinfection byproducts" suspected of being created by heating chlorinated water -- as happens in your shower -- have now been shown to enter our bodies both through skin exposure and through inhalation during showers, in a new study published in the journal Science of the Total Environment by two Queen's University civil engineers, Shakhawat Chowdhury and Pascale Champagne. The study measured the increased cancer risk posed by exposure to THMs (of which chloroform is one variant) in Ottawa, Toronto and Hamilton, and found the predicted rates highest in Ottawa (with 10 THMs potentially responsible for 10 "cancer incidents" per year) and lowest in Toronto (with 22 incidents per year, but a much population four times larger than Ottawa's). Potential ways to mitigate the cancer risk posed by THMs suggested by the authors include: altering shower-stall volume, reducing the length of showers, or changing the pretreatment processes.

Canadian researchers suggested that performing prostate cancer screenings as part of the digital rectal exam prior to a colonoscopy might help detect more cases of cancer. Of 17 physicians studied in Kingston, Ontario, however, none commented on the prostate consistently.

Depression is contagious, reported McGill researchers. If a mother has a depressive episode, then her child is significantly more likely to develop depressive symptoms within one year.

Multiple sclerosis patients' mental health comorbidities are underdiagnosed and undertreated, according to a new Canadian-American study published online this month. The Canadian contribution was from University of Manitoba neurologist Ruth Ann Marrie.

Short news bites
The Ontario government plans to create a 1-800 telephone service next month to match patients with family physicians.

Remember that safe surgery checklist the WHO is advocating? One company, QxMD Software, has already designed an application for the iPhone to put the checklist directly in doctors' hands. []

Wednesday, January 28 is the first day of the Douglas Mental Health University Institute's on the health impact of natural disasters, "the consequences of climate
change on brain development," and the effect of mothers' stress on fetal health. The conference, held in Montreal, runs through Friday. []

Want to read about the First Annual Interprofessional Health Law Conference, held January 17 at the University of Toronto? Notes on two sessions are available online.

Dr Carol Herbert, the dean of the University of Western Ontario's med school, has been named the chair of the Canadian Medical Hall of Fame board of directors. []

The January 2009 issue of the Canadian Creative Arts in Health, Training and Education Journal is now available onilne.

The first Health Wonk Review of the Obama era is online. Recommended reading includes Jared M Rhoads's essay on the Canadian healthcare system's widespread use of global budgets for hospitals leads to healthcare rationing and Neil Versel on "academic bulimia" in teaching hospitals.

Planning on watching the Super Bowl on Sunday? If you're watching the game on a Canadian television channel, you'll miss out -- like every year -- on the innovative halftime commercials that have by now eclipsed the game itself in terms of popularity. This year you'll be missing the first 3D television commercials ever aired. "But," warned the College of Optometrists in Vision Development, which apparently saw an opportunity in the commercial, "many viewers may be disappointed when they don't see the dazzling 3D effects." COVD President Dr Carol Scott said, "Research has shown that up to 56% of those 18 to 38 years of age have one or more problems with binocular vision and therefore could have difficulty seeing 3D and about five to seven percent of children have amblyopia (lazy eye) and cannot see 3D at all." Can't see the 3D ads? Head to your local optometrist for some optometric vision therapy, the COVD suggested. "It could be the single most successful eye doctor ad campaign ever created," commented Adrants. "Without a single doctor spending a single penny."

An Argentinian historian believes he's found evidence that Nazi eugenics doctor Josef Mengele managed to create a town full of blond, blue-eyed twins in Brazil when he was in hiding in the region in the 1960s. "I think Candido Godoi may have been Mengele's laboratory, where he finally managed to fulfil his dreams of creating a master race of blond haired, blue eyed Aryans," said Jorge Camarasa, author of the new book Mengele: the Angel of Death in South America.

An entire Algerian al-Qaeda cell, of at least 40 people, have died after an outbreak -- possibly the plague -- reportedly swept through their training camp. They were allegedly experimenting with biological weapons, reported The Sun. A "senior US intelligence official" told the Washington Times that the outbreak was the result of tests of "unconventional weapons" gone wrong, but said the plague was not involved.