Office colonoscopies more painful

Not only do office colonoscopies miss more cancers, as we reported back in February, they also put patients through more discomfort than hospital-based procedures. That's the conclusion of a followup study by Cancer Quality Council of Ontario's Dr Linda Rabeneck.

The new study, in the June issue of Gastroenterology, found that office colonoscopies are a shocking 3.5 times more likely to be stopped before they're completed, because of inadequate sedation.

Worried gastroenterologists have been sounding the alarm over the trend toward office-based colonoscopies for years, fearing unqualified MDs are getting in on colon cancer screening to make a quick buck.

Dr Rabeneck's study bears out some of their fears. She pinpointed three reasons office colonoscopies have such poor outcomes:

1. Standards for endoscope disinfection are poor
   
2. Doctors needn't be credentialled as endoscopists to perform the procedures
   
3. Office colonoscopies offer little or no sedation, which means they're sometimes abandoned due to patient discomfort.

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Prior complaint seals disgraced military doc's fate

Damning details of a second sexual misconduct complaint against suspended Newfoundland psychiatrist Dr James Hanley have emerged.

In a recent issue of NRM I wrote an article about how Dr Hanley's sexual relationship with a patient in Newfoundland had got him in trouble with the College of Physicians and Surgeons in New Brunswick, where he was practising as a civilian doc at CFB Gagetown. Then, just when it looked like the NB College would reinstate him, based on the fact that the Army was satisfied with his work and that his infraction was a one-time offence, this second prior complaint was revealed.

The NL College knew about the complaint but insists it was under no obligation to share the info because the complaint was withdrawn, reports the CBC. The NB College counters that this info completely changes their view that the case was an isolated incident. Dr Hanley's military bosses - once so keen to defend him - now say they have no plans to re-hire him.

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TB man's diagnosis was wrong

Andrew Speaker - the Atlanta lawyer who sparked an international incident when he travelled abroad with extensively drug-resistant (XDR) TB - didn't have the ultradeadly variety of the disease after all.

The National Jewish Medical and Research Center in Denver announced today that Mr Speaker actually has multi-drug-resistant TB, which is more treatable than XDR.

The National Jewish used different tests than the feds, one CDC official told CNN, leading Time health reporter/Harvard researcher Christine Gorman to let the CDC off the hook for its sky-is-falling reaction. Ms Gorman, however, questions whether more focus needs to be put on developing better, more reliable TB diagnostic tests.*

NRM wrote about the ethics of Canadian TB quarantines in April.

Another TB patient isn't so lucky. Shambo, a TB-positive bull who belongs to a Hindu monastic community in Wales will be put down, announced public health officials. But the Welsh monks and nuns have a plan to stop save him.

*Update, July 9: The Canadian Press on possible reasons for the diagnostic discrepancy.

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OM to CMAJ: Thanks, but no thanks

An endorsement from the CMAJ was met with tepid thanks from exiled former editors now at Open Medicine.

While congratulating their former colleagues on their new venture, the CMAJ's current editors took the opportunity to tout their own commitment to open-access publishing, putting themselves in the same league as OM and PLoS.

Writing on their blog, the OM editors thank the CMAJ for the kudos, but dispute the open access point:

"Given that CMAJ holds copyright and charges reprint and permission fees, it is not in fact an open access journal."

Update, July 4: PLoS managing editor Chris Surridge agrees with OM in a very amusing blog post.

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DCA users don't want docs' help

My recent article about two Toronto physicians who've begun prescribing cancer patients dichloroacetate (DCA) -- a neurotoxic drug that's untested for either safety or efficacy -- has some members of the discussion forum at TheDCAsite.com (sister site of a site where cancer patients can buy DCA to self-medicate) hopping mad.

Says one commenter, writing under the name "Steven":

"It's kind of foolish that these ‘experts; Dr.'s’ [sic] poke their noses into everything. I mean, it's your life and you are an adult so you can do what you want. Be it experimenting with dichloroacetate or anything else."

But when I spoke with Dr Akbar Khan, the medical director of the Toronto clinic in the article and one of the two doctors who is prescribing DCA (the other is his wife, Humaira Khan), he told me physician supervision is of the utmost importance to him. Here's an excerpt of the transcript:

NRM: Do you worry that people out there are trying DCA on their own?
Dr Akbar Khan: The concern is that patients are having side effects and not reporting it, and the drug is not stopped. I don’t recommend anybody take it without a doctor’s supervision, at least a family doctor to monitor it and do some tests. We do weekly blood tests, very comprehensive looks at organ function, kidneys, salt balance in bloodstream, and we are looking for improvement on those tests... The availability is not what worries me, I think it should be available. But it’s patients who use it on their own, without doctor supervision, that worry me.
NRM: Have you seen patients who’ve tried self-treatment?
AK: Yes, I saw one patient with lung cancer who had purchased it on the internet and tried it on his own. He had developed side effects -- vomiting and heartburn. We learned the patient was taking it in powder form, mixed into water. But that is not right way to take it. It is very acidic and it can cause burning in the mouth and throat and cause nausea and vomiting. We advised him the correct way of taking it in capsule form.

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Physicians arrested in UK car bomb plot

Seven of eight of the suspects arrested in connection with the failed car bomb attacks in London and Glasgow are physicians or med students, the BBC reports.

The eighth detainee, the wife of one of the doctors arrested, is thought to be a lab technician at a National Health Service (NHS) hospital.

On Saturday, a car filled with crude gas cylinder bombs was driven into Glasgow's international airport where it burst into flames. The day before, two cars, also packed with gas cylinder bombs, failed to explode in front of a nightclub in London.

The two men who drove the Jeep into the Glagow airport are thought to have worked at the Royal Alexandra Hospital in Paisley, where one of them is being treated for burns. The suspects appear to all hail from different countries, including Iraq, Saudi Arabia, India and Jordan.

The disturbing physician-led plots are fuelling theories that al-Qaeda is using doctors to infiltrate the UK, using their status as physicians as a cover.

Britain -- and its tabloids (with headlines like "Doctor Evil" and "Docs of War") -- have reacted with horror to the thought that its hospitals are potential breeding grounds for terror cells.

More than a quarter of Britain's doctors are foreign-trained, according to this 2005 analysis (PDF) of NHS figures.

Prasad Rao, chairman of the British International Doctors Association, told The Guardian:

"It shocked me to hear that a doctor could remotely be connected to the people who are trying to kill and maim people for no reason.... A doctor's duty, even if he finds an injured terrorist, is to give medical help. You never knowingly help or assist an individual to kill and maim others. You take the Hippocratic oath and you do not discriminate on the basis of colour or gender or religion."

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