Addictions physicians oppose mandatory-minimum sentencing
The Centre for Addiction and Mental Health, based in Toronto, announced its opposition to Bill C-15, federal legislation that would create mandatory-minimum sentences for drug crimes. "The evidence from the U.S. and other jurisdictions tells us that mandatory minimum sentences are most effective at increasing prison populations and the cost of jailing them," CAMH deputy director Wayne Skinner told a Senate committee. "Reducing the demand for illicit drugs by investing in addiction treatment, including drug treatment courts, have proven to be much more cost effective and successful approaches." [CAMH news release] The bill was passed earlier this year by the House of Commons and is now before the Senate.
Oil-sands whistleblower MD found guilty of ethics charges
The results of the College of Physicians and Surgeons of Alberta's investigation, recently leaked to the media, showed Dr John O'Connor, who made international news when he claimed to have found multiple cases of a rare bile-duct cancer in a First Nations community near the oil development sites in Alberta, violated his professional ethics code by refusing to cooperate with the investigation and, moreover, "made a number of inaccurate or untruthful claims with respect to the number of patients with confirmed cancers and the ages of patients dying from cancer." [National Post]
Quebec party's health point-man goes independent
Éric Caire, who was the Quebec ADQ party's health critic before losing a leadership contest by two votes just three weeks ago, has decided to leave the party and sit as an independent. The man who defeated Mr Caire in the leadership race, Gilles Taillon, has already announced he is stepping down and said he would likely contact the Quebec provincial police about suspected financial crimes within the party. This leaves the future uncertain for a party that just a couple of years ago was the official opposition in Quebec City and played a major role in advancing the debate on health-insurance reform in Quebec. "Is it RIP for the ADQ?" asked the Montreal Gazette.
The state of evidence-based medicine
"To enter mainstream use, any... treatment typically needs to clear a high bar. It will be subject to randomized trials, statistical-significance tests, the peer-review process of academic journals and the scrutiny of government regulators," writes journalist David Leonhardt in a new piece on evidence and intuition in medicine. "Yet once a treatment enters the mainstream — once we know whether it works in certain situations — science is largely left behind. The next questions — when to use it and on which patients — become matters of judgment, not measurement." [New York Times Magazine]
eBay's more profitable than medicine
An American FP took time off from her medical practice when she gave birth to twin girls and discovered she could make more money selling clothing on eBay -- $120,000 last year -- than she could working full-time as a doctor. [CNN]
Photo: Shutterstock
Addictions MDs oppose mandatory minimums (Nov. 12)
CAMH speaks out against Bill C-15's sentencing changes
The 7 best medical smartphone apps (Nov. 10)
"Times have changed in the PDA world"
Q&A: Dr Bonnie Henry, H1N1 flu fighter (Nov. 9)
Advice for clinicians from an expert
Thursday, November 12, 2009
What's in the news: Nov. 12 -- Addictions MDs oppose mandatory minimums
Tuesday, November 10, 2009
The 7 best medical smartphone apps
There’s revolution in the air, and it's called Wi-Fi. Wireless-internet-equipped smartphones like iPhones, BlackBerrys and Palms are more than just new variations on your trusty pager or your cell: smartphones are changing the way some physicians practice.
"Times have changed in the PDA world,” says Dr Paul Arnold, a Toronto emergency physician who used to edit the Medical Palm Review. The difference now? On-the-go internet access via Wi-Fi or 3G networking.
"It definitely has changed the way we do medicine," says Vancouver family medicine resident Jessica Otte. "I can get the information I need right away."
How are these plugged-in doctors using their smartphones in clinical settings to save time and improve patient care? Parkhurst Exchange spoke to clinicians from across Canada and overseas to find the best applications.
1. Epocrates. Without equal among mobile pharmacopeias, and by consensus the most useful app around, Epocrates provides detailed prescribing information at your fingertips. Even though it doesn’t list some Canadian formulations and is missing a few OTC drugs, it puts a library’s-worth of reliable, constantly updated drug information right in your pocket. (www.epocrates.com; all platforms; basic version free, expanded version US$159/year)
Click here to read the rest of this article on the Parkhurst Exchange website.
Image: Osirix
Monday, November 9, 2009
THE INTERVIEW: Dr Bonnie Henry, H1N1 flu fighter
In this month's issue of Parkhurst Exchange, which should be arriving on physicians' desks across the country right about now, you'll find a short Q&A with Dr Bonnie Henry (right), the BC Centre for Disease Control’s director of Public Health Emergency Management the author of the new book Soap and Water & Common Sense: The Definitive Guide to Viruses, Bacteria, Parasites, and Disease (Anansi).
Online, you can read the full version of the interview, in which we discuss the severity of this pandemic, the steps family physicians can take to make their waiting rooms safer, special billing codes for H1N1 flu consults, and the interesting and pertinent story behind how Canada decided to manufacture its own vaccines after the 1976 swine flu, among other things.
Click here to read the full interview.
Thursday, November 5, 2009
Canada is looking out for your health
A selection of our favourite Canadian health advisories issued over the last few days.
Solubilize, nebulize, die
When treating H1N1 flu patients, don't solubilize and then nebulize your powdered zanamivir (Relenza) and then put it in a ventilator. A pregnant woman died when the lactose in the powdered zanamivir combined with the liquid used to dissolve the powder and blocked her ventilator.
You'll need a miracle, inshallah
Muslim pilgrims should be vaccinated against influenza and other infectious diseases at least six weeks prior to the Hajj. The warning was issued four weeks before the beginning of the Hajj, which this year occurs November 25-30.
(But perhaps all is not lost. Some supremely strange Islamic websites interpret the word "ma'arej" from the Qu'ran to mean "wormholes" and assert that Mohammed and his angels may have used them to travel through time. So maybe you're not out of luck after all.)
"Consumable entertainment"
You may not be surprised to learn that consuming energy drinks called Mind Strike, Fearocity, Elixir of Tenacity and Power Pulse (right), made by a company called Chaotic Beverages, pose a health risk to children.
The company will certainly be shocked to hear this, considering the drinks were launched in Canada earlier this year in partnership with a company called 4Kids Entertainment, based on a children's card game (a 4-pack of the drinks came packaged with a set of the cards) and animated TV show, and were intended for children : "Fueled with natural energy from green tea extract, and loaded with vitamins, antioxidants and functional herbs, Chaotic Beverages offer kids a great tasting, healthier alternative, beverage that provides a convenient way to meet their hydration needs." (Functional herbs? Alternative to what? More convenient than, say, water? That sentence raises far more questions than it answers.)
The drinks' marketing consultants, U & Me Marketing, saw the product as so revolutionary that they invented a new classification to describe it: "Consumable Entertainment." Health Canada, it seems, wasn't amused.
Wednesday, November 4, 2009
What's in the news: Nov. 4 -- Newfoundland's first H1N1 flu death, and more
H1N1 flu news
Newfoundland and Labrador saw its first H1N1-flu death over the weekend. [St John's Telegram] [Halifax Chronicle-Herald]
Ontario's health minister, Deb Matthews, was surprisingly blunt in blaming municipal planning in Toronto for the city's slow start to the vaccination campaign, calling the work "simply unacceptable." City officials, predictably, were displeased with her assessment. [Toronto Sun]
Several PEI schools are suffering H1N1 flu outbreaks, and nearly half of students are absent 
from class in one school. [Charlottetown Guardian]
Nova Scotia's government announced it will cover the cost of Tamiflu prescriptions for all residents, regardless of their private pharmaceutical insurance coverage. [Halifax Chronicle-Herald]
An immunization campaign is underway in Ontario prisons, where the H1N1 flu has already appeared, but only inmates are being vaccinated. Guards in an Etobicoke jail staged a brief strike in protest. [Toronto Sun]
The federal agency Public Safety Canada, which has a central role in coordinating the nation's pandemic response, is still not fully functional despite years of planning, Auditor General Sheila Fraser charged. [Canadian Press]
Relying on just one vaccine manufacturer, GlaxoSmithKline, to make all of the country's H1N1 flu vaccine is a decision that should be studied after this pandemic passes to determine whether it was the best course of action, federal health officials said. [Toronto Star]
Two women got into a fight on a New York City subway car when one accused the other of endangering others by not coughing into her hand. [Business Insider]
Clorox and other companies are making a (figurative) killing on products related to the H1N1 flu pandemic. [Globe and Mail]
The Canadian Medical Protective Association, which is the legal defense fund of the country's physicians, speculated that if the H1N1 flu pandemic worsens "retired physicians, physicians who are in Canada but are unlicensed, or even medical students may be called on in a prolonged and severe disaster." The CMPA noted that licensure matters could become an issue if that were to come to pass. [CMPA]
Canadian astronaut Dr Robert Thirsk, who returns from an extended stint on the International Space Station on December 1, discussed his concern about his vulnerability to the H1N1 flu on his return from space because astronauts are known to have depressed immune responses when they disembark. [Canadian Press]
H1N1-free news
On Tuesday, Quebec's College of Physicians endorsed limited legal euthanasia in some circumstances in a position statement titled "End-of-Life Care: Getting Around the Impasse." The statement said that the question should not be whether euthanasia is right or wrong, but rather whether end-of-life care being delivered is appropriate. "We have to get beyond the logic of current legislation," said College president Dr Yves Lamontagne. "We need to move toward an appropriate care logic and adapt the legislative framework accordingly so that it allows us to reassure patients, physicians and society that the care provided at the end of an individual's life will be as appropriate as possible." [College des médecins news release] "There do exist certain exceptional situations where euthanasia could be considered by the patient and their physician to be an ultimate and necessary step in assuring the patient receives appropriate and quality care to the very end," said Dr Lamontagne. [Toronto Star]
Dr Susan Burlacoff, a Toronto MD who billed $65,000 for treatments she never provided to members of her own family, was cleared of criminal charges of billing fraud by reason of mental illness. Medical experts testified that Dr Burlacoff's psychosis caused her to believe 2,700 insurance claims over a five-year period for visits that never occurred, were valid. She remains in practice. [Toronto Star]
Friday, October 30, 2009
What's in the news: Oct. 30 -- Some MPs decline the H1N1 flu vaccine
Some MPs decline the H1N1 flu vaccine
The Hill Times has compiled a list of Members of Parliament who have stated they will not receive the H1N1 flu vaccine: "NDP MP Denis Bevington, Conservative MP Terence Young [the 
author of the 2007 book Death by Prescription: A Father Takes on His Daughter's Killer], NDP MP Don Davies, Conservative MP Brian Jean."
Mr Davies told the newspaper, "I've never had a flu shot in my life. I'm 46 and I've never had any difficulties. In my time I've seen five separate pandemic scares that have come from legionnaires' disease in the 1970s, to other swine flues, and I generally think that they tend to be overstated, the fears."
"I'm still thinking about whether or not this is a good thing for me," said NDPer Carol Hughes, a member of the Standing Committee on Health. [The Hill Times]
Conservative MP Maxime Bernier has also said he will not be getting the shot. [CBC News: Inside Politics blog]
It's obviously a matter of personal choice, and I don't think anyone would suggest that MPs should be required to receive flu shots, but maybe they should keep quiet about it if they're not going be immunized, especially at a time when public health officials are trying to convince Canadians the shot is safe and important?
More H1N1 flu news
Staff and patients have been infected by an outbreak of the H1N1 flu at Mount Sinai Hospital in Toronto [CBC News] as well as Bridgepoint Hospital. [Globe and Mail] The flu has also hit McGill University's residences. [CBC News]
The Canadian Medical Association is pleading with business owners to follow the government's lead by not asking employees to get sick notes from their doctors to demonstrate that they're unfit to come in to the office. [CMA news release]
mdBriefCase is offering an online CME course for Canadian doctors on the H1N1 flu. [mdBriefCase news release]
Another new online course for health workers, this one offered by Mount Sinai Hospital psychiatrists and nurses, called the Pandemic Influenza Stress Vaccine, instructs on how to manage the anxiety brought on by this wild and crazy flu season. [Pandemic Influenza Stress Vaccine course] [CBC News]
A Nova Scotia doctor who is obviously taking the H1N1 flu more seriously than some of our esteemed Members of Parliament, told an entire family to quarantine themselves. [Halifax Chronicle-Herald]
Did Quebec receive its fair share of H1N1 flu vaccines? The PQ, despite the Liberal health minister's claims otherwise, says no. [La Presse]
Experts from the National Advisory Committee on Immunization recommend the seasonal flu shot still be given to at-risk patients. [Canada Communicable Disease Report, Public Health Agency of Canada]
A Maclean's reporter tracked down a teenager who drinks alcohol-based hand sanitizing gel to get drunk. "The best way to drink hand sanitizer is straight, like whisky, and down it 'like a shot,' explains Tyler, a Grade 10 student who lives in Toronto. Undiluted, the alcohol-based liquid tastes a little like 'vodka and bug spray,' he adds." [Maclean's]
PEI's health minister is annoyed that the College of Family Physicians of Canada scheduled its annual conference during the beginning of the H1N1 flu's arrival this fall because 25 Islander doctors have headed off to Alberta to take part, leaving the province severely depleted of physicians. [Charlottetown Guardian]
And now for the portion of this missive reserved for non-H1N1-flu-related news...
The Canadian Paediatric Society is likely to recommend kids under the age of two not watch television at all, mimicking the American recommendations that have been in place for years. [Ottawa Citizen]
A Q&A with BCMA president Dr Brian Brodie appears in the current issue of the BC Medical Journal. The cover of the current issue has a photo of Dr Brodie astride a horse, in front of a bunch of sheep. He describes a typical day, which involves feeding his poultry and livestock before going to the hospital, and he says, "I'm not interested in wealth —- in fact everything I've read says inherited wealth isn’t good. So the goal is not to leave my kids money or to leave that kind of a legacy. I'd like to give the money away to help others who haven’t had opportunities." [BC Medical Journal] Vancouver Sun health reporter Pamela Fayerman notes that Dr Brodie earned a whopping $529,491 from his family practice alone in the last year for which statistics are available -- "perhaps the highest figure I've ever seen for a family doctor," writes Ms Fayerman. And that doesn't include his farming and real-estate ventures. [Vancouver Sun, Medicine Matters blog]
The College of Family Physicians of Canada named its family physicians of the year for 2009. [CFPC news release (PDF)]
Air Canada has applied for judicial review in the case of Henry Coopersmith. Listen to CBC Radio's Dr Brian Goldman discuss the case on the "White Coat, Black Art" episode originally broadcast on October 17. [CBC Radio's "White Coat, Black Art"] Read more about the case on Canadian Medicine.
Six out of ten provinces saw wait times drop over the past year, according to a new Fraser Institute report. [Fraser Institute news release] [Waiting Your Turn report (PDF)]
Toronto sports medicine specialist Dr Tony Galea had his office raided by the RCMP and is now charged with importing and selling illegal drugs. Dr Galea said the charges stem from a misunderstanding about his use of unlicensed homeopathic medications from Germany that he gives to athletes only with their informed permission. [Globe and Mail]
There's talk that outspoken Quebec MNA and ADQ health critic Eric Caire may leave the party after not being offered the position he wanted following his incredibly close loss in the party's leadership race. [La Presse]
Image: McNally Robinson
Wednesday, October 28, 2009
What's in the news: Oct. 28 -- Dal med school on probation: accreditation body
Dalhousie med school on probation
Dalhousie's medical school is on probation after it failed to attain accreditation from an American auditing body. The school (left) was marked non-compliant in 17 of 132 areas initially but managed to get seven of those overturned. The probation lasts up to two years, but the school is still accredited in the meantime. [Dalhousie Medical School news release] "It's a reputational black mark," Dr Tom Marrie, the school's dean, told the Canadian Medical Association Journal. "The program is still a good program. It’s still accredited." [CMAJ] [Saint John Telegraph-Journal]
H1N1 flu vaccination campaign launch marred by logistics troubles
This week is the first full week of H1N1-flu vaccination in Canada and already there have been problems. Montrealers were supposed to receive doses on Monday but logistical problems for patients and doctors alike caused a minimum one-day delay. The Gazette called Monday a "confusing non-start" but health officials said the problems were just a hiccup. [Montreal Gazette] In Calgary, Monday's vaccine roll-out was marred by similarly frustrating planning, and patients eager to get immunized left long lines without getting the shot. Alberta health minister Ron Liepert absolved himself of responsibility for the difficulties, placing it entirely on his public health staffers. [Calgary Sun] In Ontario, some patients waited as long as three hours to be immunized. [Toronto Star]
MORE NEWS FROM ACROSS CANADA
This year's Chalk River nuclear power plant shutdown, which put a strain on hospitals' supplies of radioisotopes used in diagnostic imaging exams, will delay diagnoses, Canadian Society of Nuclear Medicine president Dr Jean-Luc Urbain told Members of Parliament. "We are not necessarily going to see the effect of the shortage of isotopes today, but we'll see it six months down the road, a year down the road, two years down the road," he said. [Edmonton Sun]
New Brunswick will review 30,000 radiology reports prepared by Dr Bhagwan Jain, who is suspected of having made an unacceptably high number of errors. [CBC News]
Alberta introduced its new pharmaceutical strategy, slashing generic drug prices and promising new fees for pharmacists to make up for the lost income. [Edmonton Journal]
Saskatchewan's Tony Dagnone presented his findings as commissioner of the province's Patients First Review, with a list of recommendations for the government on ways to improve care from the patient's perspective. [Patients First Review report] [Regina Leader-Post] [Saskatoon StarPhoenix]
Taser International, the manufacturer of the controversial stun guns, issued a warning not to fire its weapons at people's chests. In addition to making the use of the weapon safer, the company's bulletin said, the new policy will enhance "the ability to defend such cases in post event legal proceedings." [Taser International safety bulletin (PDF)] [CBC News] The RCMP has already begun to change its policies in accordance with the company's counsel. [CBC News]
The federal government should include healthcare facilities in its stimulus spending, Canadian Medical Association president-elect Dr Anne Doig said, calling the decision not to do so "shameful." "The federal government has chosen not to invest these funds in health facilities, and this is inexplicable," said Dr. Doig. [CMA News]
The CMA launched a new website, ephysicianhealth.com, to aid doctors with addictions and other personal problems. [CMA News]
A Toronto hospital clerk was fired for turning away an uninsured immigrant seven-year-old who was bleeding from a head wound. [Toronto Star]
Prescription opiate abuse is on the rise in British Columbia, according to a new study from UBC. [Canadian Press]
Supervised crack-smoking sites are needed to protect users' health, said BC's public health chief.
[Globe and Mail] [National Post]
The McGill University Health Centre hospital network is now giving out free gym memberships to its breast cancer patients, based on evidence that physical activity is associated with higher cancer survival rates. McGill University researchers will follow the women given gym memberships to add to the medical literature on the subject [MUHC news release]
Doctors are to blame for the lack of access to medical marijuana in Quebec, alleged one prominent medical-marijuana activist. [Le Devoir]
Dr Ray Wiss discussed his Afghanistan experience and his new book on his time there as a physician with the Canadian Forces. [Toronto Star] Dr Kevin Patterson, an author and military veteran who has worked as a civilian physician in Kandahar, reviewed the book favourably. [Globe and Mail] Dr Wiss published some of his diaries last year in the National Review of Medicine, not long after returning from the war. [NRM]
Six physicians and researchers were named to the Canadian Medical Hall of Fame: Alan C Burton, James Hogg, William A Cochrane, Vera Peters, Phil Gold, and Calvin R Stiller. [Canadian Medical Hall of Fame]
Photo: Dalhousie Medical School
Tuesday, October 27, 2009
Details of new NB Medical Society deal released
The terms of the new contract the New Brunswick Medical Society and the provincial government signed last month [Canadian Medicine] have been released: 3.75% per year raises for four years, retroactive to April 1, 2008, followed by a two-year wage freeze from 2012 to 2014. [Government of New Brunswick/NBMS joint statement]
That's a big improvement on what the government initially brought to the negotiating table, which was zero.
In fact, the new deal is one of the two options (1: the initially-agreed-upon four-year contract with a two-year wage freeze preceding it; or 2: the initial deal with a two-year freeze following it) the government presented to the physicians this past summer, before then-health minister Michael Murphy changed his mind, retracted the offer and oversaw the legislature's drafting of a law [Bill 93 (PDF)] that gave the government authority to unilaterally override the original (wage-freeze-free) version of the deal, agreed upon in 2008.
Image: Government of New Brunswick
Monday, October 26, 2009
Do doctors need "reputation management" lawyers?
Earlier this month, on the Canadian legal news website Slaw.ca, University of Western Ontario law student Omar Ha-Redeye made a really interesting prediction: one area of the law that's sure to see growth in the future is something he calls "reputation management," and physicians are perhaps chief among the clientele that's likely to demand that service.
Mr. Ha-Redeye uses as a jumping off point for his argument my recent article in Parkhurst 
Exchange about an Alberta urologist named Mohamed Foda who this year became the first physician anywhere (as far as I can tell) to force RateMDs.com to disclose the names of anonymous reviewers.
The Foda case against RateMDs is tied in with another suit he is involved in in Edmonton and it all gets very complex very quickly, but the long and short of it is that Mr. Ha-Redeye seems to see Dr Foda's successful efforts to fight back against anonymous online libel as one of the first of a forthcoming trend of "reputation management" lawsuits.
What do you think? Are we going to see the development of a new field of reputation management law? Should the Canadian Medical Protective Association be in the business of not only protecting physicians from malpractice suits, as they do now, but also protecting their reputations?
Wednesday, October 21, 2009
Canada approves H1N1 flu vaccine
Arepanrix, GlaxoSmithKline's vaccine against the pandemic H1N1 flu, was today given Health Canada's stamp of approval. "This is a milestone in our efforts to fight the pandemic H1N1 flu virus," Health Minister Leona Aglukkaq said in a statement. "Thanks to careful planning we now have a safe and effective vaccine being distributed to provinces and territories that they will be rolling out in a matter of days."
The Public Health Agency of Canada's vaccination recommendations are as follows:
- All Canadians 10 years of age and older should receive one dose of adjuvanted vaccine;
- Children from six months and up to 10 years of age should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart;
- Children age 0-6 months – immunization not authorized; and
- Pregnant women should receive one dose of the unadjuvanted vaccine, of which Canada has ordered 1.8 million doses. In cases where the unadjuvanted vaccine is unavailable and pandemic H1N1 flu rates are high or increasing in the community, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine.
