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Monday, June 29, 2009

Recent severe cases of H1N1 flu worry health officials

In a teleconference with reporters this afternoon, federal health officials provided an update on the current state of the Canadian government's response to the H1N1 flu pandemic.

Health Minister Leona Aglukkaq -- who has kept a fairly low profile in her time at the helm of Health Canada throughout the H1N1 response as well as the radioisotope shortage crisis -- was in attendance but said little besides mentioning that she'd be traveling to Mexico soon alongside foreign governments' delegates to discuss at a World Health Organization meeting how to deal with the expected resurgence of the H1N1 virus this fall.

Dr David Butler-Jones, the government's Chief Public Health Officer (above right), said that although the vast majority of the 7,775 cases detected in Canada so far (see the map below for a breakdown by province or visit the ) have been mild and have resulted in full recoveries, the anticipated "second wave" of infections this fall has been preceded already by the mysterious appearance in recent weeks of a small number of "severe" infections.


According to Dr Butler-Jones, the reason or reasons for the emergence of this new set of "severe" cases in Canada has not been determined, though epidemiologists with Health Canada and the Public Health Agency of Canada have been dispatched to study the matter. Possible explanations, he explained, could include: genetic variations that result in either too little or too great an immune response in infected patients, a mutation in the H1N1 virus (which would augur potentially very serious consequences in the general population over the months to come, it would seem), or some combination of factors. He warned that we should expect to see more cases in Canada over the coming months, including more severe cases, and more deaths.

At the top of the news lately have been accusations that the federal government's response to the rapid spread of the H1N1 flu virus in aboriginal communities, particularly in Manitoba, has been insufficient. Health Canada's regional director of First Nations and Inuit Health, Valerie Gideon, endeavored to convince reporters that was not the case. The shipments of hand sanitizer, which had been delayed because of concerns that the alcohol-based gels might be abused by First Nations patients, have now been delivered, she said, and nursing stations are open on the reserves 24 hours per day and are stocked with necessary medical supplies.

One interesting item to note about Monday's news conference was the tone that Dr Butler-Jones employed when discussing recommended precautionary measures for pregnant women and people with preexisting health conditions, both of which groups of patients may be at higher risk of experiencing dangerous complications if they are infected with the H1N1 flu. Whereas US Vice-President Joe Biden was mocked not long ago for warning people to avoid crowded places like buses and trains for fear of catching the virus, Dr Butler-Jones said very seriously that pregnant women in Canada should consider staying out of crowds. He refused, however, to cite specific crowded places pregnant women should avoid; he demurred when asked by one reporter if he meant women should avoid shopping malls and public transportation, only mentioning for certain (and this is where things took a brief turn for the surreal) that pregnant women should avoid mosh pits.

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David Caplan aims for better, cheapter healthcare

It's been said that the Canadian model of healthcare insurance promises three things: high-quality care, for everyone, quickly. Reality falls short of the promise, of course. As the saying goes: pick two.

But David Caplan (left), the man selected to follow the controversial George Smitherman as health minister of Ontario a year ago this month, intends to make good on that promise. Universal coverage is a given, of course, but as for quality and efficiency -- well, let's just say that Canada is no . Maintaining a high level of quality has in some cases meant reduced access and longer wait times, and it's likewise assumed that providing all patients with family physicians (and the enviable same-day access patients in some other countries get) would compromise doctors' ability to give patients sufficient attention and deliver appropriate care.

Complicating matters is the fact that the rate at which governments' health spending has been increasing has outstripped growth in GDP for years, and seems likely to do so for years to come.

Mr Caplan's ambitious goal as health minister is to turn that move beyond the quality/wait-times binary and to save money in the process.

He explained his thinking to me in a long interview for the June issue of Parkhurst Exchange magazine:

"What I want to do is raise the quality of the healthcare experience, of healthcare service, because all of the literature I've read says that when you increase quality you increase efficiency and you increase sustainability and cost-effectiveness. That's the real way. The mistake I think governments have made in the past is they've tried to contain costs first and what you've seen is a degradation of quality. If you raise quality, and that's the goal, almost by definition it will logically follow that cost-effectiveness will result."
on the Parkhurst Exchange website, for more on health policy as well as a discussion of following in his mother's footsteps as health minister of Ontario, the decline and future of solo practice, Mr Caplan's struggles with his weight and smoking addiction, and more.

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Friday, June 26, 2009

What's in the news: Jun. 26 -- Manitoba First Nations declare H1N1 emergency

Manitoba First Nations declare H1N1 flu emergency
Chiefs of Manitoba First Nations have declared a state of emergency as the H1N1 flu pandemic ravages their already-troubled communities.

The chiefs lay the blame for the virus's quick spread on the federal and provincial governments, whom they say failed to act early enough.

"No one is taking responsibility," David Harper, of the Garden Hill First Nation, told the Winnipeg Sun. "We've crossed the line. We've had enough." []

One point of contention is that deliveries of hand sanitizer were delayed because of concerns that the alcohol-based gels would be abused by First Nations patients trying to get drunk. A government official confirmed the reason for the delays. "The discussion was with the best interests of our clients in mind," Anne-Marie Robinson, the assistant deputy minister of the First Nations and Inuit Health Branch of the federal health ministry. "We have had some rare experiences in our communities where we have had theft of hand sanitizers. … We do have communities where we have large proportions of people who suffer from addiction. … We have had a number of people come forward, and some evidence, where this could potentially put people at risk."

The delivery took two and half weeks to arrive, while the flu was making its way through the towns. []

First Nations have higher infant mortality, TB rates
Canadian First Nations peoples have higher infant mortality and tuberculosis infection rates than the rest of the Canadian population, a new UNICEF Canada study showed. []

More news from across Canada

- Quebec appeared poised to abandon its public-private partnership plans for the construction of the forthcoming Montreal mega-hospitals. []

- Newfoundland MDs demanded higher pay in their next agreement with the provincial government. []

- A Canadian HIV expert prepared to begin an innovative new study that might lead to treatments that could not only suppress the virus's ability to reproduce but actually eliminate it from the body completely. []

- Knee and hip joint surgeries, though they are expensive, actually save the public healthcare system money in the long run. (No pun intended.) []

- The burden of chronic diseases presents a challenge particularly for women, who are now living longer than ever before. So says a new study from St Michael's Hospital and the Institute for Clinical Evaluative Sciences, in Toronto. []

- The Coalition of Family Physicians of Ontario, a doctors' group that tends to oppose the Ontario Medical Association and the provincial government in part because they inhibit doctors' freedom to practise as they wish, pointed to a recent essay by health law experts Lonny Rosen and Elyse Sunshine that concluded "concern remains that doctors will find themselves embroiled in more conflicts and other proceedings as a result of the College's enhanced investigative powers and the increased information disclosure required by the new amendments." [] The laws were passed as part of a major health regulatory reform package known as Bill 141, back in April. [Canadian Medicine]

- Some MDs are concerned about a recent British Columbia law that permits naturopaths to do allergy testing. The Canadian Society of Allergy and Clinical Immunology, the British Columbia Medical Association and other groups have expressed their worries to the health minister. []

- The Supreme Court gave its okay to governments' practice of forcing Jehovah's Witness minors to receive blood transfusions if deemed medically necessary. However, the court's decision made clear that judges should use their discretion to determine whether the minor is capable of making a responsible decision before enforcing a transfusion. []

- A drug called aprepitant was found to reduce chemo-induced nausea and vomiting. The new evidence was presented at the Multinational Association of Supportive Care in Cancer, in Rome, yesterday. It has not yet been published in a peer-reviewed journal. []

- Alcohol is linked to one in 25 deaths worldwide, reported researchers from Toronto's Centre for Addictions and Mental Health. [] [] []

- A Saskatchewan doctor was fined for refusing to report to the hospital when he was on call and for attempting to treat himself at the hospital. []

- A Winnipeg Children's Hospital doctor was charged with child sex abuse. [] []

- The government of Canada passed regulations banning the sale of plastic baby bottles containing the chemical bisphenol A (BPA). "Our Government is acting to protect its most vulnerable citizens-newborns and infants," Health Minister Leona Aglukkaq said in a release. "Canada is the first country to move ahead with regulations to prohibit polycarbonate baby bottles that contain bisphenol A. We want parents to feel confident that they can safely bottle-feed their newborns and infants." [] Why has no other country acted yet? Because there's no firm evidence that bisphenol A is actually dangerous, wrote Terence Corcoran. []

- You may soon be seeing fewer vaccine ads. (The fact you see any at all in Canada is because vaccines are not covered under the ban on direct-to-consumer drug advertising.) In response to complaints, Health Canada is demanding drug companies insert more safety information into their advertising material. []

- Health Canada, in issuing a health advisory warning consumers of the dangers of reusable cloth shopping bags and the bacteria and mould they could potentially collect, has effectively backed the plastics industry. [] Who underwrote the "study" that alerted the public to the health risks that could theoretically arise from the contaminated cloth bags? Why, it was the plastics industry! []

- Dr PC Adams, published in the Canadian Journal of Gastroenterology an essay titled "The impact of cirrhosis on the history of jazz." [ (free full-length PDF available)]

- Canadian blogger and new family practice resident Dr Ottematic contemplated joining the Canadian Forces for the great salary and the medical training, but decided (for the time being at least) not to enlist. []

- Kevin Megeney, the Nova Scotia soldier killed inside a NATO base in Afghanistan in 2007, was shot by a fellow soldier while they played a game of "quick draw," alleged crown prosecutors. [] After he was shot, Mr Megeney was treated by a civilian physician on contract with the military named Kevin Patterson, from BC. Dr Patterson went on to publish a graphic account of the episode in an excellent article he wrote for the American political magazine Mother Jones. Dr Patterson later conceded that published Mr Megeney's name was unethical and agreed to donate his earnings from the article to charity and pay a fine to the BC College of Physicians and Surgeons. [Canadian Medicine]

- This week's Health Wonk Review includes a whole section devoted to Canada. In it are articles by blogger The Ismological [""] and by Canadian Medicine. []

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Thursday, June 25, 2009

New health ministers in New Brunswick, Nova Scotia

NB replaces health minister in midst of crisis
After a calamitous and bruising weeks-long battle with the province's physicians, New Brunswick Health Minister Mike Murphy has been removed from the health ministry and sent to run the justice department.

Mary Schryer (left) has been named the new health minister. []

Of course, that's hardly a demotion or a sign that Premier Shawn Graham is going to reverse the decision that precipitated the fight with the doctors -- the government's recent recession-influenced decision not to honour the agreement on raises it came to with the doctors' union last year -- and it appears so far that Mr Murphy's departure is unlikely to change the situation. But the appointment of a new health minister is at the very least a sign that Mr Graham and perhaps even Mr Murphy as well recognized that Mr Murphy's relationship with the medical community was irrecoverably damaged.

"Michael Murphy's departure from the Department of Health is welcome," commented the Telegraph-Journal. "A lawyer by profession and debater by temperament, he was never suited for a portfolio that must be above partisan politics. It's not surprising that his most prominent reforms have drawn threats of legal challenge." As for Mr Schryer, the newspaper remarked, "She'll have her hands full trying to re-open negotiations with physicians, address the doctor shortage, and bring order to a health system so overloaded that patients are being housed in shower stalls." []

Ms Schryer was a financial planner and a director on the board of the Atlantic Health Sciences Corporation before entering politics.

But while Mr Murphy's exit from the health portfolio might be seen as a positive development in what must inevitably be some variety of reconciliation between doctors and the government, there's no guarantee that as justice minister he will be, as the Daily Gleaner put it, be "in less of a position to trample all over people the way he did with the doctors' wage freeze fiasco." [] The reason for that is because there is a strong possibility that he could end up directly involved with the doctors once again, since the New Brunswick Medical Society has now threatened to take the government to court over its decision to break the deal it had promised to the society last year.

Perhaps it will not come to that, however. Mr Graham appears to have gradually come to realize the folly of angering nearly the entire medical profession in one fell swoop and he has made some initial overtures to the medical society, saying he would like to reopen negotiations. [] So far, the NBMS has refused to return to the table. []

But Bill 93, the legislation essentially authorizing the government to ignore the commitment it made last year, has indeed been passed by parliament but it has not been proclaimed yet, leaving open some potential room for Mr Graham and Ms Schryer to maneuver.

Nova Scotia also gets new health minister
New NDP premier Darrell Dexter named Maureen MacDonald the province's health minister. [] Ms MacDonald was a social work professor at Dalhousie before entering politics. [] She also worked as a community health educator, a legal aid worker, and a journalist. []

Just before Ms MacDonald's name was announced, the Chronicle Herald's Ralph Surette penned a column with his advice for the new minister. He advised her, "you don’t have to overhaul the general policy direction... Indeed, the only policy challenge you have is to reverse your party’s crazy promise to keep all rural ERs open all the time. In order to keep that vow, you’d have to strip the primary care system of doctors, pay doctors more than they make in their offices to staff ERs overnight, when in fact there’s very little business and the ambulances take real emergencies elsewhere. This is not just bad policy, it’s nuts. You’d be paying doctors a fortune for basically doing nothing." []

Former health minister Karen Casey, meanwhile, took over as interim PC leader as defeated premier Rodney MacDonald stepped down. []

Ontario opts not to replace health minister
In a move that surprised some in Ontario, Premier Dalton McGuinty shuffled his cabinet slightly but chose not to appoint a new health minister to replace the embattled David Caplan, who has been under fire from opposition members for several weeks in relation to the untendered contracts handed out by the eHealth Ontario agency.

BC health minister still getting acclimated
BC Health Minister Kevin Falcon, who has only been on the job for about two weeks since being switched over from the ministry of transportation, offered a rather confused analysis of public-private balance before calling a Vancouver Sun reporter back to explain himself. [] Our guess: don't read too much into this exchange. We figure Mr Falcon was just trying to keep up with an experienced reporter and let his mouth get ahead of his brain. It's doubtful he was forming new policy on the fly.

In a new article, Canadian Healthcare Technology wondered if new Mr Falcon will opt for the same kind of de-regionalization, or at least a limited variant thereof, that Alberta and New Brunswick have experimented with in recent years. []

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Monday, June 22, 2009

New Brunswick breaks deal with doctors

The New Brunswick government followed through on Health Minister Mike Murphy's (left) threats and, last Thursday, passed Bill 93, effectively eliminating the wage increases the province's physicians had been promised in negotiations last year. [ (PDF)]

The New Brunswick Medical Society's reaction was -- not surprisingly -- one of disappointment but not surprise. Society president Dr Ludget Blier (right) issued a statement condemning the government and making clear that physicians don't intend to take this provocation lightly. In other words: you'll be hearing from their lawyers, Mr Murphy. Dr Blier's is so strongly worded that it's worth reading in full:

If there was any remaining doubt about the level of respect that the Shawn Graham government has for New Brunswick doctors, it was wiped out on June 18, 2009 with the third reading of Bill 93. This historic piece of legislation will render a duly negotiated and ratified agreement to be "null and void", and will attempt to block any efforts to challenge that decree.

The president of the New Brunswick Medical Society, Dr. Ludger Blier, says that it is difficult to find words that are strong enough to express how he and his fellow physicians feel about how they have been treated over the past eighteen months or more. "Used and abused are words that come to mind", says Dr. Blier. "We spent many days, weeks and months across the negotiating table from government representatives before finally signing off, page by page, on the terms for new agreements. We placed those terms in front of our membership for a vote, with a recommendation that they accept them. Our membership respected the results of the negotiations process. Government did not."

Dr. Blier underlined once again that the decision to single out physicians and walk away from signed agreements was enough to seriously damage the relationship between physicians and the Graham government. The way that the Government chose to do that has reinforced the conclusion reached by the doctors, that the only remaining avenue for efforts to salvage the agreements is through the courts.

"We met with the Premier on March 11th at which time he told us that we had choices about how to participate in the government's restraint policy and that the 'negotiating process would be respected' if that was our choice. The Premier subsequently said that we misunderstood and were never given a choice." Dr. Blier points to a document that was given to the Premier on March 19th and letters that were sent to government on April 6th and April 23rd, as evidence of the Society's contention that there was a choice.

"The Premier has invited physicians to return to the negotiating table but only if we agree in advance that the government's policy of two years of "0" would be up front", says Dr. Blier. "Is that a true negotiation, or an attempt to bring some legitimacy to unacceptable behaviour?"

Dr. Blier says that the Medical Society will continue to pursue what legal options are open to physicians to protect the duly negotiated agreements.
For more on the ongoing battle between the government of New Brunswick and the province's doctors, read Canadian Medicine's previous coverage of doctors' threats to strike and campaign against the Liberals and our coverage of the recession-induced origins of the government's decision to rescind its offer of raises to the doctors.

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Friday, June 19, 2009

What's in the news: Jun. 19 -- “Spotty progress” on wait times

"Spotty progress" in latest Wait Time Alliance report card
The 2009 report card by the Wait Time Alliance, its fourth annual one, shows small improvements on some measures in some provinces, but the authors of the report, entitled Unfinished Business, insist that is not enough. [ (PDF)]

Unfortunately, the report card's accuracy is inherently limited by the lack of reliable data collected and disseminated by the provinces. That in itself is one of Canada's major hurdles in the struggle to reduce wait times, according to the report's authors. "People can go online and track the progress of a package they shipped from one end of the country to another, yet in many parts of Canada patients still cannot find out how long they can expect to wait for critical medical treatments and procedures," Dr Lorne Bellan, a co-chair of the Wait Time Alliance, said in a release. "We need to do a better job of tracking and reporting on the full wait that patients experience to access necessary medical care." []

Dr Robert Ouellet, the president of the Canadian Medical Association (which is a member of the Wait Time Alliance), commented Thursday, "Right now, patients receive excellent care, but too often it is in spite of the system, rather than because of it." []

The WTA is a research and advocacy group formed by associations of medical specialists from a number of fields of medicine.

Presumably coincidentally, a Vancouver-based company called Timely Medical Alternatives announced plans to offer patients faster specialist access -- for a fee.

The company's president, Rick Baker, claimed the new service is not illegal. "All we will be providing is research," he said. The government has not yet evaluated the new service's legality.

The company has made headlines in the past with the service it currently offers patients: it will connect them with American facilities and physicians to treat patients faster than they can be treated in Canada. []

Controversy pushes chair off eHealth Ontario board
eHealth Ontario board chair Dr Alan Hudson has resigned from the agency's board as controversy continues to rock the province's Liberal government after it was reported that millions of dollars of contracts given to consultants were not opened up for bidding. [] []

Dr Hudson, a neurosurgeon and former president of Toronto's giant University Health Network group of hospitals, was largely responsible for the province's wait times reduction efforts over the last several years.

CEO Sarah Kramer was dismissed from her job last week for similar reasons. [Canadian Medicine]

In discussing the recent dismissal of Ms Kramer and Dr Hudson's departure, Premier Dalton McGuinty said, apparently with a straight face, "The buck stops with me."

No H1N1 flu field hospital in Manitoba
Health Canada declined requests to set up a field hospital to combat the fast spread of the H1N1 flu in First Nations communities in a remote area of Manitoba especially hard hit by the virus. []

The H1N1 flu has been spreading particularly quickly in Manitoba of late. []

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Thursday, June 18, 2009

What's in the news: Jun. 18 -- Isotope alternatives not as safe

Isotope alternatives not as safe: doctors
With fewer and fewer radioisotopes available to nuclear medicine specialists, some doctors are turning to older diagnostic scanning methods.

Robert Atcher, the president of the US-based Society of Nuclear Medicine (which held meetings this week in Toronto), said that alternative scanning techniques and materials are less safe and less effective than the molybdenum-99 that is now in short supply globally. []

Some Canadian nuclear medicine experts are complaining publicly that the government should have consulted them before appointing Dr Alexander McEwan the new radioisotope-shortage adviser to the health minister. "We feel the nomination of an individual without proper consultation infringes on his ability to speak freely to the government, and we feel that if he was nominated by his peers and if he had to respond to his peers, he would have to do a better job," Dr Norman Laurin, the president of the Canadian Association of Nuclear Medicine, said. "If you've been picked personally by a minister and not the object of a formal recommendation, you are somehow indebted to that minister." []

And, in what is perhaps an unnecessarily obvious observation, the Toronto Star's editorial board bemoaned the fact the government has much, much more to do to solve the problems the radioisotope shortage has posed. "This crisis will not be solved by wishful thinking in Ottawa." Drat! []

C-sections not always needed in breech births
At its annual meeting in Halifax, the Society of Obstetricians and Gynecologists of Canada announced that its latest guidelines on delivering babies in the breech position will state that C-sections are not always necessary. [ (PDF)]

"Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic," Dr Robert Gagnon, one of the authors of the guidelines, said in a release. "What we've found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery."

Of course, as is true in all medical specialties, changing guidelines is no guarantee that many practitioners will be changing practices. But SOGC president Dr André Lalonde has acknowledged as much. "The onus is now on us as a profession to ensure that Canadian obstetricians have the necessary training to offer women the choice to deliver vaginally when possible." []

But in the current issue of the Journal of Obstetrics and Gynecology Canada Dr Andrew Kotaska, from the Northwest Territories, questioned how useful it will be to put the effort in to teach obstetricians how to avoid caesarean sections. [ (PDF)]

Treatment and travel
The June issues of and magazines are now available online.

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Wednesday, June 17, 2009

What's in the news: Jun. 17 -- Quebec breast cancer scandal leads to lawsuit

Lawsuit over Quebec breast cancer test scandal
A request has been filed to begin a class-action lawsuit against the province of Quebec over the breast cancer testing problems that were recently brought to light. The request was made by breast cancer patient and community organizer Marianne Tonnelier, who described the government's handling of the news that as many as 20% of breast cancer hormone tests could be flawed as "offensive" and "reckless." []

Earlier this month, Health Minister Dr Yves Bolduc (right) took the advice of a panel of experts he had convened and announced the province would re-do 2,100 tests to make sure no patients were being treated incorrectly. [Canadian Medicine]

Isotope shortage felt across Canada
Up to 12,000 Quebec patients have had their cardiac and cancer diagnostic tests postponed over the last two weeks as a result of the ongoing radioisotope shortage. "No one has died in Quebec because of this crisis, but if it continues, that could happen," Francois Lamoureux, the president of the Nuclear Medicine Specialists Association of Quebec, said. []

CTV News reported dozens of delayed tests in BC, Alberta and Saskatchewan. Most hospitals appear to have been able to get by so far on what they had in storage from their last shipments, but supplies of radioisotopes are dwindling. []

Health Canada announced on Monday that it has approved a source of the radioisotope technetium-99m that had previously not been available to Canadians. The approval should lead to an increase in the supply of necessary isotopes, the agency said. [] []

Meanwhile, Ontario and Alberta researchers have developed a replacement for molybdenum-99, called F sodium fluoride, which can be produced in existing cyclotrons in several Canadian cities. []

MSF Canada appoints new president
The Canadian branch of Doctors Without Borders has appointed Halifax family doctor Joni Guptill its new president. Dr Guptill, who helped establish the Canadian branch in 1991, takes over from the departing Montreal pediatrician Joanna Liu. Dr Guptill has treated patients in humanitarian disasters in Turkey, Somalia, China, Iraq and Sudan.

In a release, Dr Guptill said, "I like the challenge. I like working with people from other cultures. There's nothing more rewarding, more satisfying than doing a job well where the need exists. I've always wanted to do this kind of work, and it's been the most satisfying work of my medical career."

Grand Rounds
The excellent American medical profession newspaper ACP Internist hosted this week's edition of Grand Rounds, the anthology of the best medical blogging from around the web. Canadian Medicine is proud to account for the entire international contingent this week. []

Photo:

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Friday, June 12, 2009

What's in the news: Jun. 12 -- Stoking American fear of Canadian healthcare

Expatriate MD warns of "deadly" Canadian healthcare
Dr David Gratzer (right), a physician who left Toronto for greener pastures in New York, published an op/ed in the Wall Street Journal earlier this week, describing the supposed folly of the Canadian healthcare model and explaining why the United States should not follow suit. [] He wrote:

"Not long ago, I would have applauded this type of government expansion. Born and raised in Canada, I once believed that government health care is compassionate and equitable. It is neither.

"My views changed in medical school. Yes, everyone in Canada is covered by a 'single payer' -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system."
Dr Gratzer, who is affiliated with the Manhattan Institute think tank, is promoting an argument riddled with holes. He not only commits the error of illustrating his points with anecdotal stories (these happen in every country) but also presents a distorted picture of the difference in overall health outcomes produced by Canada and the United States by selecting only limited examples of rationing. Other misleading assertions: that the 2005 Chaoulli decision, which overturned the Quebec government's right to outlaw all types of private insurance in all situations, indicates a wholesale repudiation of the public healthcare model that is employed with minor variations in every province; and that the Canadian Medical Association's recent predilection for electing reformist presidents is an indicator of much more than the organization's role as a lobbying body on behalf of the interests of physicians. (Plus, how does this part of his argument account for the CMA membership's 2009 election of Dr Jeff Turnbull, whose basic philosophy of the role of private healthcare funding in the public system is anathema to those of Drs Brian Day and Robert Ouellet?)

The real problem, though, is that his logic is essentially as follows: the Canadian healthcare model has serious problems, ergo giving the US federal government a larger role in healthcare insurance is a potentially "deadly" proposition. Few people would dispute the premise of Dr Gratzer's argument -- that Canada is struggling to provide necessary healthcare services to all its residents within a reasonable amount of time -- but that is far from sufficient to justify his conclusion.

For more, read the comprehensive takedown of Dr Gratzer's argument by the left-leaning watchdog organization Media Matters for America. []

And, similarly, New York Times columnist Nicholas Kristof recently endeavoured to discredit the popular criticisms of "government takeover" and "Canadian-style" healthcare, in light of an advertising campaign designed to combat proposals to establish a system of universal healthcare in the United States. []

Physicians vs New Brunswick
The rolling boil of the dispute between New Brunswick doctors and the provincial government is on the verge of boiling over into full-scale war.

Doctors are still smarting from the government's threat to implement legislation to prevent the province's doctors from receiving the modest raises they agreed to provide them with just last year. [Canadian Medicine] On Friday, the New Brunswick Medical Society is holding an emergency meeting to determine what to do next; things have gotten so bad that the union's leadership has been openly speaking about the prospect of "job action." "All options will be on the table," president Dr Ludger Blier said. "We are not ruling out anything yet." [] (You can read Dr Blier's recent statement on how the crisis arose .)

The dispute has some doctors actively opposing the governing Liberal Party. "Doctors have certainly lost all trust in Minister Murphy and have probably lost faith in the governing provincial Liberals," said Saint John Medical Society president Dr David Iles. "We're going to counsel our patients not to vote Liberal... There's a lot of anger among medical society staff and doctors across the province about how we've been treated." []

In his public statements, Health Minister Mike Murphy has sounded only partly cognizant of the effect his tactics have had on the medical community. He has offered to negotiate some "non-monetary" aspects of doctors' contracts. "I do recognize that that leaves a very bad taste in physicians' mouths for years to come. I'd like to see that avoided," Mr Murphy told CBC News. "I certainly hope that I'll receive a phone call, and I certainly invite that phone call, and we would have some discussions as soon as possible to see if we can get to that common ground. I think we can. I'm sure we can." []

The rapidly escalating war in New Brunswick is, in essence, the result of the current recession's deleterious effect on government revenues. Explaining the rationale for reneging on the collective agreement the government and the doctors agreed on last year, Mr Murphy said simply, "Things dramatically changed." []

The decision of the New Brunswick Medical Society about what to do next was to have been announced at a press conference Friday evening.

eHealth Ontario boss fired
Sarah Kramer, the embattled CEO of the eHealth Ontario agency tasked with developing an electronic health records system for the province, has been fired in the wake of news reports detailing questionably distributed consulting contracts. []

The opposition has called for Health Minister David Caplan's head but Premier Dalton McGuinty has backed up his minister as well as eHealth Ontario board chair Dr Alan Hudson, who is also responsible for the province's wait times strategy. [] []

Ms Kramer's severance package amounted to $317,000. []

Healthy new faces in BC cabinet
Premier Gordon Campbell, fresh off yet another election victory last month, has named a new health minister to his cabinet. Kevin Falcon, who had been transportation minister before the writ was dropped, will take over the job from George Abbott, who had been the longest serving provincial health minister in the country, and will now head the Ministry of Aboriginal Relations and Reconciliation.

Dr Margaret MacDiarmid, an ex-president of the BC Medical Association who won a seat in the legislature for the first time, was named minister of education.

Dr Moira Stilwell, a radiologist and nuclear medicine specialist and UBC lecturer, was also elected to the legislature for the first time. She was assigned to cabinet as well, as minister of advanced education and labour market development. []

MB First Nations struggling with H1N1 flu
Garden Hill First Nation, in Manitoba, is having a tough go of it in the fight against the H1N1 flu pandemic. In the past week, The Globe and Mail reported, 11 residents of the small community have had to be airlifted to better equipped facilities. "We are in a war with no artillery," Chief David Harper said. "I'm looking at several medevac planes, but still no masks, no hand sanitizer, no new equipment to speak of. I've been asking for this stuff for over a week and nothing has improved." []

Will Alberta's centralized health governance model work?
Globe and Mail health columnist André Picard wrote, "The single most important person in Canadian health care today is someone you have likely never heard of: Stephen Duckett, the new chief executive officer of Alberta Health Services." []

QC will screen for colorectal cancer
Quebec Health Minister Dr Yves Bolduc announced that his province will begin to provide screening for colorectal cancer. []

Psychiatrist loses licence for sex abuse
An Ottawa psychiatrist, Dr Samuel Malcolmson, had his licence to practise revoked by the College of Physicians and Surgeons of Ontario for sexual abuse. He had sex with a patient of his over a two-year period, both in his office and elsewhere, gave her money, and even fathered a child of hers. Dr Malcolmson pleaded no contest. []

A public-private medical school?
Reading two health officials' call for a new medical school in the Fraser Health Region of BC [], Vancouver Sun health reporter Pamela Fayerman heard an appeal to consider a public-private partnership model to build it. []

Q&A
Health policy expert Steven Lewis interviewed outspoken former BC deputy minister of health Penny Ballem. []

Mind doesn't matter for BP: study
Psychological treatments for high blood pressure are ineffective, a new University of British Columbia study revealed. []

MD arrested for attacking police car

Dr David Henry, of Fort Erie, Ontario, was arrested and charged with mischief under $5,000 after he kicked and punched a police car during a protest at the local hospital. Dr Henry was among a group of people angry about the closure of Douglas Memorial Hospital's emergency department. "It's a crime being perpetuated by the NHS under the (Local Health Integration Network) and supported by the provincial government," he said. "(Thursday) night was a rally showing our frustration." []

Nova Scotia docs get a new leader
Halifax orthopedic surgeon Ross Leighton was elected president of Doctors Nova Scotia. "The doctors of the province have identified emergency medicine, long-term care, recruitment and retention of physicians, health promotion, and electronic medical records as priorities," he said in a release. "The system needs to undergo dramatic change and improvements. To do that effectively doctors need to be involved in developing solutions."

Montreal hospital workers boycott dress code
Employees of three Montreal hospitals are refusing to follow a new dress code that forbids them from wearing jeans, short skirts, or from displaying tattoos that management judges to be in poor taste. On Monday, when the dress code was to take effect, many employees arrived at work wearing jeans. []

Grand Rounds
The latest edition of Grand Rounds is online. []

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It's official: H1N1 flu is a pandemic

The World Health Organization has finally decided to raise its pandemic warning to the highest level, phase 6, indicating that the H1N1 flu has become the .

In a issued Thursday, WHO director-general Dr Margaret Chan said, "We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch." The 2009 pandemic is unusual in that it is the first to be subjected to such careful scrutiny from its very beginnings, she said. "No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness."

Dr Chan warned, however, that our "head start" doesn't mean we will be able to prevent many of the dangers of pandemics. "Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems."

In response, public health officials immediately jumped into action. Quebec public health officials held a news conference Thursday afternoon and updated the government's .

Ontario public health officials also held a news conference, essentially to announce that they are already doing everything they can. "We have a plan in place to monitor and assess the H1N1 flu virus," acting chief public health officer Dr David Williams. "We will continue to implement that plan with our partners and agencies and to coordinate our response activities with the Public Health Agency of Canada."

According to the Public Health Agency of Canada -- which now nearly 3,000 laboratory-confirmed cases of H1N1 flu across Canada, in every province but Newfoundland and Labrador -- Ontario's reaction is appropriate. The Canadian repsonse does not need to be changed in light of the WHO's new decision to declared H1N1 flu a pandemic, reported PHAC officials. "Since the beginning, Canada has taken decisive action to address the H1N1 Flu Virus and protect Canadians," Health Minister Leona Aglukkaq . "Today’s decision by the WHO does not change our approach. Entering Phase Six means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan."

In Montreal, infectious disease specialist Dr Brian Ward, of the McGill University Health Centre, with the H1N1 flu.

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Thursday, June 11, 2009

Isotope crisis sets off political meltdown

The Halifax Chronicle Herald yesterday it had come into possession of a misplaced audio recording made in January of Natural Resources Minister Lisa Raitt (below) -- the minister responsible for the nation's nuclear facilities and radioisotope supply -- calling the then-impending radioisotope shortage a "sexy" political issue and eagerly anticipating the political benefits of solving the crisis by throwing money at it.

Unsurprisingly, if not entirely deservedly, her use of the word "sexy" to describe an issue that pertains to thousands of cancer patients' and other patients' health has been met with pleas for sympathy from weepy patients on the evening news and harsh recriminations by members of the opposition in Ottawa. Never mind that the word "sexy" is used by almost every politician across Canada and in most newsrooms as well, as an indignant Christie Blatchford (is that redundant?) in The Globe and Mail.

Opposition members predictably stood up in the House of Commons to demand Ms Raitt resign from cabinet, which she in fact offered to do. Prime Minister Stephen Harper, however, refused to accept her resignation.

And while all this blustering and bickering takes up the attention of the government and the national news media, the radioisotope shortage only continues to get worse as supplies dwindle. Patients' tests have already been delayed because of the lack of isotopes, and the Toronto Star reported that this week the government's isotope plan is beginning to fail -- in part because foreign production cannot seem to fill our demand -- and hospitals will soon have no isotopes left to use in diagnostic imaging exams. []

When our elected representatives are done sniping at one another as the parties position themselves for a potential federal election this year, will they finally figure out how we are going to get ourselves out of this mess? Our guess: probably not anytime soon. The major barrier is that solving the problem would require some acknowledgment of mistakes that have been made over the past decade or two. But as should have been made clear by now, that kind of intellectual honesty is simply radioactive.

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Wednesday, June 10, 2009

NDP wins majority in Nova Scotia

Darrell Dexter's New Democrats won a majority in Tuesday's Nova Scotia election, as the Progressive Conservatives fell from the seat of power to third place behind the Liberal Party. []

The new NDP government, led by new Premier Darrell Dexter (left), inherits an interesting and fairly ambitious five-year collective agreement made between the last government and Doctors Nova Scotia last year. [Canadian Medicine] It will be interesting to see how the NDP reconfigures its health policy priorities to accommodate the agreement, and it will be just as interesting to see what kind of changes Mr Dexter will want to make to the "transformational system-wide realignment" plan of early 2008, which he was critical of when it was released. []

If you'd like to know what kinds of health policy promises were made and positions were advanced by the NDP during the campaign, you can consult the Doctors Nova Scotia voting guide .

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Friday, June 5, 2009

What's in the news: Jun. 5 -- Feds buy heroin for Vancouver addicts

Gov't funds free-heroin clinic in Vancouver
Health Canada gave its approval to a research clinic in Vancouver that goes well beyond the mandate of the controversial safe-injection Insite clinic: this new one will distribute free heroin to addicts. The research project is called SALOME and is a follow-up to NAOMI. [] []

In related news, the Ontario Press Council dismissed a complaint made by Drs Thomas Kerr and Evan Wood -- two BC scholars who have been among the leading researchers in the world on the effects safe-injection clinics have on HIV/AIDS rates -- against The Globe and Mail for a column by Margaret Wente that they felt impugned their reputations as researchers. []

Quebec will re-do 2100 breast cancer pathology tests
Acting on the recommendation of a committee of medical experts, Quebec Health Minister Dr Yves Bolduc announced on Thursday that 2,100 breast cancer pathology tests would have to be re-analyzed to ensure no errors are adversely affecting patients' treatment. The committee was formed in response to a study issued by the Quebec Association of Pathologists that found very high error rates in breast cancer pathology tests. []

Isotope shortage gets political
Natural Resources Minister Lisa Raitt took a shot at the federal opposition this week when she said that, because foreign suppliers will be able to fill Canadian demand for radioisotopes while the Chalk River nuclear plant is shut down, there is no need to overreact. "I think it's incredibly important that we don't have fear mongering for people in Canada with respect to this issue," she told a House of Commons committee investigating the radioisotope shortage. []

Little did she know at the time she'd soon be on the defensive. One of Ms Raitt's aides had left behind secret documents showing undisclosed spending on Chalk River at the offices of CTV News the week before, the news organization reported. [] Surely thinking back to the incident that forced Maxime Bernier to step down from cabinet, Ms Raitt offered Prime Minister Stephen Harper her resignation but he declined it. The aide responsible for the documents, however, was fired. []

Liberal leader Michael Ignatieff, surely sensing an opportunity for political gain, hinted that the Chalk River shutdown could become an election issue, while some journalists have been talking about the possibility of a summer or fall federal election. []

A quick round-up of more recent health news
An international team of researchers, including Canadians, found that the HPV vaccine Gardasil offers at least eight years of protection against the virus. []

Quebec announced a universal newborn hearing screening program. []

The first class of doctors has graduated from the Northern Ontario School of Medicine. []

A Montreal man was forced to deliver his baby in the Royal Victoria hospital in downtown Montreal without help from nurses or physicians. "The nurse did come by our room twice but didn't really come in but just stood at the door and said, 'I'll be there in a few minutes, I'll be there in a few minutes,'" said the father. "I just put my hand on his chest, and my fingers around his armpits, and my other hand kind of on his face …and I just pulled him out." []

Privacy-law confusion may harm health research, reported a new Canadian study. []

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Thursday, June 4, 2009

With Nova Scotia election approaching, MDs provide voting guide

There's less than one week left until the . Current polls have the NDP poised to form a government, forcing the incumbent Progressive Conservatives into opposition.

But, of course, the results are not decided until the last ballot is counted. So for doctors and patients alike who are still unsure of how they are going to vote, Doctors Nova Scotia has put together a that includes not only the medical association's position on five important health policy topics (physician recruitment, emergency care, long-term care, healthy living, and electronic medical records) but also the positions of the Tories, the NDP and the Liberals on those topics, to help voters discern where the parties stand.

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Wednesday, June 3, 2009

What's in the news: Jun. 3 -- Mr Layton goes to Washington

Layton pitches health reform in US
NDP leader Jack Layton is in Washington, DC, this week to talk to Obama administration officials and American audiences about how to implement a universal healthcare system. "We know the Americans can't just simply adopt our model, walk it across the border and put it in place," he said. "But the principles of universality, of access and of insuring that health care's available to everybody, those kinds of principles are very much motivating the Obama administration."

American adoption of universal healthcare would dissuade some of Canada's healthcare critics, like former CMA president Dr Brian Day, said Mr Layton (left). "If Obama succeeds, it helps us hang onto our public health care system because they're [proponents of privatization] always chipping away at it, trying to say that we need to privatize." [] []

Update, Wednesday, June 3: You can read the full text of Mr Layton's speech this morning at the Woodrow Wilson Centre .

Review Quebec breast cancer test errors: critics
Quebec Health Minister Dr Yves Bolduc last week tried to dismiss concerns that a new study by the Quebec Association of Pathologists proved that high test error rates meant that tests would have to be re-done. [Canadian Medicine]

Dr Bolduc began this week trying to play down the implications of the study and saying the story had been blown out of proportion when other medical experts suggested thousands of tests might need to be repeated. "That is totally false," he said. []

Dr Bolduc said reporters had misinterpreted the study. "The experts have concluded that it is not true to say that a variation observed in the results in terms of quality means that there is the same variation in terms of wrong tests or inappropriate treatment." He also blasted Dr Gaétan Barrette, the president of the Federation of Medical Specialists of Quebec union, who had suggested the error rates were the result of government mismanagement of the healthcare system. "He's speaking for a union, he does not represent any professional association of quality," Dr Bolduc said. "You have to look at his credibility in that context." Dr Barrette told CBC News that Dr Bolduc's criticism was "outrageous." "Where did he do his medical training?" fumed Dr Barrette. [] He must have forgotten. Dr Bolduc received his MD from Université Laval, class of 1981.

But despite Dr Bolduc's pleas for calm, the controversy has grown. On Monday, the provincial College of Physicians and Surgeons called for a committee of experts to be set up to investigate the proper course of action. [] On Tuesday, Dr Bolduc not only acquiesced but also announced that pathology tests would hereby be subjected to quality assurance, which they had not all been previously. [] The committee will make recommendations to him at the end of the week. []

Things are looking grim for Dr Bolduc now. One of the Quebec Association of Pathologists researchers said some cancer tests will have to be repeated. [] And the opposition ADQ party is calling for Bolduc to resign because of this issue as well as prior problems it cited. [] Dr Amir Khadir, a Montreal infectious diseases specialist elected to the National Assembly last year, called on Dr Bolduc to stop delaying and confusing the public and instead get down to work right away to get to the bottom of the issue. []

Isotope shortage begins to affect patients
Reports from across Canada tell of the test delays and cancellations doctors have been forced to make as a result of the radioisotope shortage caused by the shutdown for safety repairs at the Chalk River nuclear plant in eastern Ontario. The shortage is affecting doctors and their patients in , , , , and elsewhere, and delayed exams are all but certain to be the norm in many regions.

The political fallout (please forgive the pun) from the Chalk River shutdown has continued to accumulate.

An editorial in the Toronto Star pointed out the contradictions inherent in the government's vastly different responses to the 2007 and the current Chalk River shutdowns. The 2007 shutdown, for three weeks, prompted the government to pass emergency legislation to permit the plant to open without the safety repairs that were recommended. Natural Resources Minister Gary Lunn said, "Had we not acted, people invariably would have died, since medical isotopes for serious cancer procedures were not available, and we could not let that happen." Now, with a minimum of three months of down time at Chalk River, Health Minister Leona Aglukkaq has said, "It's not a crisis." The Star concluded, "Stephen Harper's Conservative government is either dramatically underplaying the current medical isotope crisis or wildly overplayed the last one." []

Trouble follows eHealth Ontario spending spree
Both opposition parties are calling for Ontario Health Minister David Caplan's resignation after revelations of profligate spending by the government's agency responsible for electronic health records, eHealth Ontario.

It came to light recently that the agency's CEO, Sarah Kramer, handed out $4.8 million in "sole-sourced" contracts, or contracts that were not opened up for bidding.

Subsequently, other expenses incurred at the agency became known. Ms Kramer's $380,000 salary; her $114,000 bonus; her $1,700/day executive assistant; $300/hour consultants who read newspaper articles, reviewed Ms Kramer's holiday voicemail greeting, and briefed her as she rode on the subway. []

Sharing in the populist anger, the Toronto Star discovered expense claims for a $3.19 "dessert square" and a $1.65 Tim Hortons tea made by an eHealth consultant who was being paid $2,700/day.

Interim Tory leader Bob Runciman called eHealth a "rogue agency out of control." []

In response to the criticism, eHealth Ontario has hired an independent consulting firm to perform an audit of its spending. []

Hey, doctors: don't discriminate
In the current issue of the College of Physicians and Surgeons of Nova Scotia's quarterly magazine ALERT, the regulatory body reported an instance in which a physician allegedly refused to treat a pregnant patient because she had opted to take advantage of the recently introduced publicly funded midwifery system. Something is seriously wrong when regulators have to remind doctors, "Patients who are considering or who have chosen the services of a midwife expect and deserve to be treated in a non-discriminatory manner by their physicians." []

Straining credulity
A very modern disease: cell-phone elbow. []

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Tuesday, June 2, 2009

Recession puts raises promised to New Brunswick MDs in jeopardy

No one, it seems, is immune from the havoc the current recession is wreaking on the economy. Medicine is sometimes called "recession-proof" but when physicians are paid by the government, as they are in Canada, shrinking government revenues mean that the state's rapidly emptying coffers affect doctors much as they do civil servants.

Facing budget shortfalls, New Brunswick Health Minister Mike Murphy has asked the province's doctors to set aside the two-year contract they agreed on with the government last year and instead accept a two-year wage freeze. The government hasn't signed the agreement and may refuse to pay the doctors' raises regardless of the medical society's response to the minister's pleas.

Setting aside the raises would save the province's health system $36 million, Mr Murphy said. If that money isn't saved on doctors' pay, he said, it will have to come from cutbacks somewhere else. "If we were to turn the tentative agreement into a full agreement, we undoubtably would have to close down hospitals and shut down programs. Then the question is, where would we do that?"

Progressive Conservative health critic Margaret-Ann Blaney accused the government of negotiating in bad faith last year. "They have sabotaged this process from day one," said Ms Blaney. "They have shown the doctors no respect." []

Saint John Medical Society president Dr David Iles was pessimistic that physicians could stop the government from imposing its will. "We can ask for binding arbitration, but likely the government will legislate the freeze," he told the Telegraph-Journal. "If you look across the country, no other provincial government has imposed a freeze on doctors so they continue to have raises in salaries... Just to stay competitive across the nation, you need to at least honour our contract. Our salaried docs are well behind other doctors in the region."

New Brunswick doctors will simply leave the province if pay is frozen, said Dr Don Craig, the president of one of the province's medical staff organizations. "A loud sucking sound will hit the east and away we go." []

Mr Murphy, meanwhile, has apparently set out to make the province's physicians look like the bad guys. "There are patients of physicians in this province who are undoubtedly suffering some angst over the economy and the inability, sometimes, to pay the mortgage or pay for their children," he said in the legislature last week, implying the doctors shouldn't complain about their high pay. "We are looking for the co-operation of the medical society's members for merely 10 more months so that we can meet a common goal of restraint." []

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