Are You Going to Use Finasteride for Hair Loss? Read This First

Sold in the market under the brand names Propecia and Proscar, finasteride is a medication that is intended to treat people who are suffering from hair loss.  In the early days, finasteride was just like other medications that were originally used to treat benign prostatic hypertrophy and prostate cancer. It turns out that patients who took finasteride for their prostate-related issues had experienced great results with it, along with a surprising bonus, and that is, the growth of hair.

Finasteride actually works by means of inhibiting or stopping type II 5-alpha reductase, the enzyme responsible for converting the hormone testosterone into dihydrotestosterone (DHT).  DHT, in turn, is the one responsible for losing one’s hair, resulting to baldness if not remedied.  Thus, simply put, the action of finasteride is to prevent the conversion of testosterone into DHT, and the end result would be the prevention of hair loss. This “favorable side effect” of preventing hair loss and promoting growth of new hair by finasteride is what made it famous in the pharmaceutical world, not by its primary use which is for treating benign prostatic hypertrophy and other prostate-related ailments. Read more…

Government agencies play the listeriosis blame game

In a new report on last year's listeriosis outbreak, Dr David Williams, Ontario's acting chief medical officer of health, lauded the province's response to the problem but criticized the Canadian Food Inspection Agency (CFIA) for allegedly failing to give "timely access" to information to public health workers about potentially contaminated products.

The communication problem between jurisdictions "contributed to public confusion and created the impression that the outbreak was not being well managed, which affected public trust and confidence in the public health system," Dr Williams wrote. He also said that "the Office of the Chief Public Health Officer [Dr David Butler-Jones] at the PHAC [Public Health Agency of Canada] did not appear to have a clear mandate for leadership in a cross-jurisdictional foodborne outbreak." []

Dr Carolyn Bennett, the federal Liberal Party's health critic, called the report's conclusions a damning indictment of Stephen Harper's government, according to Toronto Community News. "As soon as any problem gets into the food chain, we must have a public health response," said Dr Bennett. "This is what we thought we put in place from the lessons learned from SARS. We know from SARS, germs don't respect borders. There is no place for jurisdictional bickering in an outbreak like this." [].

But some of Dr Williams's most serious accusations -- including that federal bodies delayed access to information -- are in dispute. The CFIA, Health Canada and Dr Butler-Jones all signed a letter demanding Dr Williams correct what they say are mistakes in his report. "The document contains a number of statements which should be clarified and corrected for the public record." The letter claimed that Toronto Public Health was responsible for the delays because it sent food samples to the wrong laboratory, and it also said that Dr Williams was incorrect in claiming that the CFIA was late in identifying the source of the outbreak (a Maple Leaf Foods plant).

On the same day that newspapers reported on the letter of complaint sent by the federal agencies, Ontario's Ministry of Health announced Thursday that Dr Williams, who has been the acting chief medical officer of health since November 2007, will be replaced by Dr Arlene King, who is currently working at the Public Health Agency of Canada as director general of the Centre for Immunization and Respiratory Infectious Diseases. Dr Williams will return to his former job as associate chief medical officer of health. []

Photo: Shutterstock

Investigate "institutional racism" in healthcare: indigenous MDs

In light of the deaths of three First Nations patients in Manitoba healthcare facilities in the past year, the Indigenous Physicians Association of Canada has called for a review of "institutional racism" in medicine across the country.

In a issued today, the IPAC summarized the cases of the three patients who died:

Brian Sinclair, a 45-year-old man who died of an infection, which spread from a blocked bladder catheter after waiting in the emergency room for 34 hours. An inquest is pending, and all parties including Premier Gary Doer have agreed that his death was preventable.

Chace Barkman, a 6 month old baby, died of meningitis with a six-day delay in receiving the correct diagnosis and obtaining appropriate care at the Garden Hill Health Centre considered a possible contributing factor to the death.

MayLynn Sanderson, a 34 year old female, died of a heart infection within 24 hours of being transferred from a correctional institution to a hospital. According to the Winnipeg Free Press Sanderson had previously been hospitalized for this condition, and had been requesting further treatment since February 9th. She wasn't transferred until April 5th and died on April 6th.
The IPAC admits that it's unknown whether racism was at play in those three cases.

But all of them were all First Nations patients and racism "may have been a contributing factor," IPAC president Dr Marcia Anderson wrote. "The anecdotal evidence suggests an intolerably high level of racism in health care, and so does the formal evidence." For those reasons, the organization is recommending a "systematic review for multilevel racism (i.e. institutional and interpersonal) within the health care system."

In today's release the IPAC directly challenges Manitoba's Ministry of Health to perform a review of racism in the healthcare system, in tandem with the IPAC. (The ministry made no public response today.)


Waiting-room death triggers review of Quebec private clinic rules

Quebec coroner Catherine Rudel-Tessier's , who died January 11, 2008, in the waiting room of a private Montreal urgent-care clinic, demands that the Collège des médecins du Québec refine its regulations on such clinics to better protect patients.

Ms Rudel-Tessier said the 2007 Collège guidelines on private clinic administration should be "more precise" on certain points and must help administrators "offer a safe environment to their patients and permit them to adequately deal with emergencies."

The Collège's president and CEO, Dr Yves Lamontagne, said the guidelines would be either revised or replaced, depending on the results of the Collège's investigation of the incident. He said he expects two new measures will be incorporated into the guidelines. "One, every physician or nurse working in that type of clinic should follow a course on cardiopulmonary resuscitation. And two, all clinics should have equipment -- a defibrillator."

Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.

Dr Jacques Chaoulli -- the same crusading Jacques Chaoulli whose high-profile 2005 Supreme Court case against the government of Quebec forced the province to overturn some of its restrictions on private health insurance -- examined Mr Sauvageau minutes after he stopped breathing and decided not to attempt resuscitation, instead leaving Mr Sauvageau's body in his waiting room seat until an ambulance arrived. An autopsy later revealed that Mr Sauvageau died of massive bilateral pulmonary embolisms and would not have been saved by resuscitation but Ms Rudel-Tessier concluded that Dr Chaoulli could not have known that at the time and should have tried to save Mr Sauvageau.

Dr Lamontagne told Canadian Medicine that an investigation into the circumstances surrounding the death of Mr Sauvageau is already underway. The results should be made public in a month or two, said Dr Lamontagne.

NB: To learn more about the private "network clinic" model used at the clinic where Mr Sauvageau died, see Canadian Medicine's earlier coverage here.

What's in the news: Apr. 21 -- Military sees rise in psych problems

Soldiers suffer psychiatric injuries
More than one in five Canadian soldiers returning from combat in Afghanistan are diagnosed with psychiatric illnesses including post-traumatic stress disorder, reported the Toronto Star.

"Is it an epidemic? No," retired Canadian colonel Don Ethell, the head of the military's and RCMP's mental health advisory committee, told Star reporter Allan Woods. "It's just finally a realization that in addition to physical injuries, the maimed and the injured and so forth, it's also a mental price that Canadians have to pay and many of them, and many of us, have paid that without knowing where to go."

The military's handling of mental health problems has been a subject of discussion before in the medical profession. You may recall that Canadian Medicine reported on a controversy that emerged during last August's Canadian Medical Association annual meeting in Montreal, when physicians voted to pass a resolution pertaining to military mental health care. The resolution -- which said the CMA would "work with the Department of National Defence to provide high quality evidence-based mental health services to Canadian Forces members and their families resulting from operational stress injury including post-traumatic stress syndrome" -- along with comments from some doctors about what they saw as insufficient screening and treatment of PTSD by the military, were seen by a Canadian Forces physician as an insult to the military's medical system. [Canadian Medicine] It will be interesting to see whether the topic resurfaces this summer at the CMA's next annual meeting, in Saskatoon.

Suicide's toll on young Inuit men
Suicide is 28 times more common among Inuit men from age 15 to 24 than among southern Canadian men of the same age group, a new report said. [ (PDF)]

The report is intended as a step towards developing a comprehensive territory-wide suicide prevention strategy. []

More Quebec doctors opting out of medicare
In January 2007, 113 doctors in Quebec, 61 of them GPs, had opted out of the public healthcare system. By January of this year, that figure had climbed to 179 opted-out doctors, 105 of whom are GPs. "Depuis trois ou quatre ans, le nombre de nouveaux médecins non participants chaque année est nettement en augmentation," Dr Louis Godin, the president of the Federation of General Practitioners of Quebec, told La Presse. "Avant, on en avait un ou deux (omnipraticiens) par année, mais maintenant, c'est à coup de 18, 20 ou 22 par année qu'ils quittent le réseau... Pour nous, il y a là un signe qui souligne la difficulté que les médecins de famille ont dans leur quotidien à travailler dans les bureaux et cabinets privés à l'intérieur du régime public." [La Presse]

Alberta health cuts continue
Alberta Health Minister Ron Liepert said a $500 tax credit to subsidize citizens' fitness expenses was abandoned in this year's provincial budget because it would have cost the government too much money. He said the government will consider reinstating it in the future. A Calgary Sun editorial called the decision "shortsighted."

Mr Liepert also said he would review all health facility construction projects approved before he became health minister.

Mental health report tough on Alberta
A report prepared for the Alberta government and leaked to the opposition NDP revealed that the province has just one quarter the number of mental health beds compared to the national average. NDP leader Brian Mason accused the government of trying to suppress the report. "The government knew the mental health system in our province was broken, but they hid that fact from the public, the buried the truth and they buried this report." Health Minister Ron Liepert denied that the report was intentionally denied to the public.

Tamil-Canadian doctors ask for aid
As the Sri Lankan civil war appears to be entering its final stage and the New York Times asks "", the Canadian Medical Dental Development Association and the Medical Institute for Tamils called on the government of Canada to intervene in the "humanitarian tragedy." []

Sparked by nurse's murder, Ontario seeks to protect workers
The government of Ontario introduced legislation intended to curb workplace harassment more than three years after the murder of nurse Lori Dupont by her ex-boyfriend Dr Marc Daniel, a Windsor anesthesiologist. The opposition NDP, however, complained that the bill is "very weak" because it would not mandate Ministry of Labour investigations in the event of reports of harassment or abuse. []

Six Months in Sudan

Canadian Medicine is pleased to republish the first chapter of Dr James Maskalyk's new book, , about the time he spent working for Doctors Without Borders in Abyei.

the end.

I decided that this book should start at the end. It is the place I am trying most to understand.

This is it. I am standing in a field watching sparks from a huge bonfire float so high on hot drafts of air that they become stars. It is autumn in upstate New York, and the night is dark and cool. Wedding guests huddle together, white blankets loose over their shoulders. They murmur, point at the fire, then at the sparks.

I am standing by myself, swirling warming wine. A man to whom I had been introduced that night, a friend of the bride, rekindles our conversation. He is talking about an acquaintance, a nurse, who worked during an Ebola outbreak in the Congo years before. He recounts her story of how, after days of watching people die of the incurable virus, she and her team decided that if there was nothing to offer those infected, no treatment, no respite, they would give them a bath. They put on goggles and masks, taped their gloves to their gowns, and cleaned their sick patients.

Before he can go on, I stop him. I can’t talk about this.

“I’m sorry. No, no, it’s okay. It’s nothing you did. I’m going to go inside. Glad to have met you.”

I had been back from Sudan for a month. I had worked there as a physician in a small overwhelmed hospital run by the NGO Médecins Sans Frontières. I returned to Toronto sick and exhausted but convinced I was going to make the great escape. I was working in emergency rooms again, surrounded by friends. Things would be like always.

In this field of cold grass, where hours before my friends had been married, I heard ten seconds of a story, and during them realized there were things I had not reckoned on.

It was the taping of the gloves. The whine of the white tape as it stretched around their wrists, forming a seal between their world and the bleeding one in front of them. I could imagine the grimness with which it was done, could see the flat faces of the doctors and nurses as they stepped into the room.

As he was talking, I cast back to the measles outbreak that was just starting as I arrived in Abyei. One day we had two patients with measles in the hospital, the next day four, the next nine, the next fifteen. The rising tide of the epidemic soon swept over us.

I rewound to a film loop of me kneeling on the dirt floor of the long hut we had built out of wood and grass to accommodate the surge of infected people. I was kneeling beside the bed of an infant who was feverish and had stopped drinking. I was trying, with another doctor, to find a vein. The baby’s mother sat helpless on the bed as we poked holes in her child. She was crying. She wanted us to stop. Small pearls of blood dotted his neck, his groin. We failed, his breathing worsened, and he died. I stood up, threw the needles in the sharps container, and walked away to attend someone else. Behind me his mother wailed. I can see my flat face.

Who was that person? I am not sure if I know him, not sure that I want to.

People who do this type of work talk about the rupture we feel on our return, an irreconcilable invisible distance between us and others. We talk about how difficult it is to assimilate, to assume routine, to sample familiar pleasures. Though I could convince myself that the fissure was narrow enough to be ignored, it only took a glance to see how dizzyingly deep it was.

The rift, of course, is not in the world: it is within us. And the distance is not only ours. We return from the field, from an Ebola outbreak or violent clashes in Sudan, with no mistake about how the world is. It is a hard place—a beautiful place, but so too an urgent one. And we realize that all of us, through our actions or inactions, make it what it is. The people I left behind in Sudan don’t need us to help them towards a health system that can offer immunizations— they need the vaccine. Fucking yesterday. Once that urgency takes hold, it never completely lets go.

Just as our friends wonder at our distance from their familiar world, we marvel at theirs from the real one. We feel inhabited by it. We plan our return.

I have done this work before, but I have never looked back. Now I will. I am going to wear that flat face again, toss and turn in a tangled bed. But I also will feel, for the second time, the cool relief when a child I had bet everything on started to recover, to stand close to the young soldier who volunteered to give blood to a woman he didn’t know, to visit again the members of my small team. Some of the work in repairing the world is grim; much of it is not. Hope not only meets despair in equal measure, it drowns it.

This book started as a blog that I wrote from my hut in Sudan. It was my attempt to communicate with my family and friends, to help bring them closer to my hot, hot days. It was also a chance to tell the story of Abyei, Sudan, a torn, tiny place straddling a contested border in a difficult country. Mostly, though, it was where I told a story about humans: the people from Abyei who suffered its hardships because it was their home, and those of us who left ours with tools to make it easier for them to endure. It is a story that could be told about many places.

The blog became popular. Part of me wants to believe it was because of my writing, but that’s not it. It is because people are hungry to be brought closer to the world, even its hard parts. I went to Sudan, and am writing about it again, because I believe that which separates action from inaction is the same thing that separates my friends from Sudan. It is not indifference. It is distance. May it fall away.

So, this is where I stand, at the end. In the dewy grass, sparks stretching to the sky. It is cold away from the fire, and I shiver. In the distance I can see light bursting from the farmhouse door. Inside, people are dancing. I thrust my hands into my pockets and walk across the field, away from the end, towards the beginning.

Excerpted from Six Months in Sudan by James Maskalyk Copyright © 2009 by James Maskalyk. Excerpted by permission of Doubleday Canada a division of Random House of Canada Limited. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.