A bizarre fact-checking war is heating up around new CMA president Dr Brian Day.
Dr Day's accession to the CMA presidency begat a fact-check (PDF) on his reform ideas by the Canadian Health Coalition, which in turn begat a fact-check of that fact-check (PDF) by the Brian Day-founded Canadian Independent Medical Clinics Association, which in turn begat a fact-check of that fact-check of that fact-check (PDF) by the Canadian Health Coalition.
Does anybody else think "fact"-checking should be slightly less partisan?
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Showing newest 33 of 40 posts from August 2007. Show older posts
Showing newest 33 of 40 posts from August 2007. Show older posts
Friday, August 31, 2007
Spinning the facts on Brian Day
NRM's exclusive on Dr Kevin Patterson gets national coverage
Our new article about Dr Kevin Patterson's legal troubles with the Canadian military attracted some attention this past weekend from the Vancouver Sun and other CanWest newspapers, including the National Post, the Victoria Times-Colonist and the Nanaimo Daily News.
In our August 30 issue, Dr Patterson (left) made his first -- and, so far, only -- public statement about the case. The Department of National Defence announced in August it would investigate him for disclosing the name and treatment details of a soldier he treated for a gunshot wound during a recent stint as a civilian physician in Afghanistan. The soldier, Cpl
Kevin Megeney (right), was killed by "friendly fire" and complaints from his hometown sparked the DND's two separate investigations into Dr Patterson's Mother Jones article.
Reprinted here is the full text of Dr Patterson's statement made to NRM, August 10 by email:"Talk to Me Like My Father," which appeared in the July/August issue of Mother Jones, is an emotional, accurate and admiring description of the ISAF troops in Afghanistan and their sacrifices. The essay describes the horror of war in strong language, but to understand the extent of the ongoing sacrifice of the troops, I believe that strong language is necessary. If the public is to get a sense of the price being paid on our behalf by these young men and women, it is necessary to face with open eyes the grotesque nature of war trauma. The recent disengagement and fatigue of the public with these matters is itself grotesque. Reasonable people may disagree on the prospects for a durable solution in Afghanistan, but no one could dispute that these young men and women are there for us, and that it is our duty to understand what it is they endure in order to truly honour them for their courage -- and in order to make appropriate decisions about what is to be done in the future.
The investigation into Cpl Megeney's death is ongoing, as are the Military Police and the Health Services branch investigations into Dr Patterson's disclosure.
Kevin Megeney's immediate family was approached by Mother Jones magazine prior to the publication of this piece, and his mother's response was strikingly gracious. Nevertheless, it must have been painful for anyone who loved him to have read this. My intention was to honour their son and brother.
In the meantime, Dr Patterson can continue practising in BC, according to a Nanaimo Daily News article.
Photo of Dr Patterson: NRM
Photo of Cpl Megeny: Department of National Defence
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Montreal couldn't handle a disaster: doctor
Dr Tarek Razek, the trauma chief at the McGill University Health Centre, says Montreal's public-health and emergency systems are unprepared for a disaster or a terrorist attack, reports the Montreal Gazette.
Tarek Razek said hospital staff would be stretched too thin to cope if Montreal suffered from an event like the 2004 bombing of the train network in Madrid or Hurricane Katrina along the Gulf of Mexico in 2005, in which thousands of people were injured.Is Dr Razek's warning a helpful push towards improved emergency medical coverage, or is it alarmist? Tell us what you think in the comments.
"In Montreal, we have very, very severe deficiencies in our overall response capacity," Razek said yesterday afternoon at the conclusion of the 42nd World Congress of Surgery, held at the Palais de congrès this week.
Photo: MUHC
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Don Cherry, COLD-fx cleared in federal investigation
The makers of the OTC drug COLD-fx and company spokesperson/hockey commentator Don Cherry have been let off the hook in an NDP-initiated lobby ethics investigation in Ottawa, reports the Montreal Gazette.
NDP ethics critic Pat Martin called for the inquiry after the pugnacious former Boston Bruins coach and other COLD-fx employees met with Prime Minister Stephen Harper privately in 2006 and gave him a signed hockey jersey and a case of COLD-fx pill bottles.
Soon after, COLD-fx received regulatory approval from Health Canada to market COLD-fX as reducing "the frequency, severity and duration of cold and flu symptoms by boosting the immune system," reports the Gazette. "Company shares jumped nearly 60 per cent in the wake of the news," notes the article.
But the federal registrar of lobbyists ruled the meeting "did not constitute a sufficient amount of time to be considered a significant part of their duties."
UBC pharmacology professor James McCormack last year criticized COLD-fx's healing claims.
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Therapeutic orgies endorsed by Canadian government-funded institute
A rather unfortunate phrasing in this week's Canadian Institutes of Health Research newsletter:Group sex therapy can help beat erectile blues
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Tuesday, August 28, 2007
Email saves - not wastes - doctors' time
Patients whose physicians use email tend to come in for fewer office visits, writes CanadianEMR about recent research. In other words, all those concerns that email would eat up doctors' time were unfounded - in fact, email use appears to save time.
Dr Alan Brookstone, who runs the physician-discussion website CanadianEMR, admits that most Canadian doctors are also concerned about other email-related issues, including privacy and security problems and the absence of a public-insurance remuneration model.
I wrote an article about those issues in the June 30 issue of NRM.
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Grand Rounds: Volume 3, Number 49
Check out the blog Rickety Contrivances of Doing Good to read this week's edition of Grand Rounds, a weekly collection of the best writing from medical blogs.
Included in this week's edition is a mention of Canadian Medicine's recent continued coverage of the controversial US malpractice-insurance firm Medical Justice and its war on RateMDs.com.
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Toronto MD ponders internet addiction
Is internet addiction real? That's what The Globe and Mail today asked Dr Bruce Ballon (right), a youth addictions and gambling specialist from the Centre for Addiction and Mental Health, in Toronto.
His response? "It isn't a problem unless it's a problem."
Thankfully, he explains himself:In my experience, problem behaviours centred on the Internet, gaming and online gambling often arise out of a failure to find a coping strategy for underlying mental-health issues.
But here's something that not everyone knows: Dr Ballon himself is a gaming enthusiast (albeit a more old-fashioned kind of game, without electronics). In 2004, NRM profiled Dr Ballon and his award-winning vampire role-playing game, "Unseen Masters."
These issues include Asperger's syndrome (the problem Internet behaviour would be trying to find out everything about a topic by constantly researching it); pathological gambling (getting stuck on the casino sites); social anxiety disorder (chats, role-play gaming worlds); obsessive-compulsive disorder (obsessed with something that keeps them tied to the Internet); substance use disorders (ordering and researching ways to use drugs), and sexual "addiction" (seeking and downloading pornography).
Tumultuous events in a teen's life - loneliness, being bullied or parental divorce - can also be at the root of a problem.
In short, technology is not the sole issue - it's really how Internet use and online habits interact with a person's unique makeup that determine whether there are the seeds of a problem.
In June, the American Medical Association elected not to label excessive video-game playing as a psychiatric addiction, insisting more research is needed. (Read the AMA-commissioned policy paper.)
Despite the decision not to include internet addiction in the ICD-10 or DSM-IV, there's advice available to help you recognize the signs and symptoms of the condition, published in Advances in Psychiatric Treatment earlier this year (subscription required).
Photo of Dr Ballon: NRM
Photo of internet café: NPR
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Monday, August 27, 2007
Queen's U plans new School of Public Health
The Ontario government today announced a $200,000 grant to Queen's University to help plan a new School of Public Health.
The program, leading to a master's degree in public health (MPH), could open as soon as September 2008, according to the initial announcement from Queen's. Dr John Hoey, the former editor-in-chief of the CMAJ who was unceremoniously canned by CMA boss Graham Morris last year, is advising the principal on the matter:“The plan is to enroll 45 students in the first year, and, by increments, increase to 120,” Hoey said. Hoey added that the University recognizes the need for a school of public health because many other universities already have such schools in place, and because of a growing workforce demand for experts in public health. The master’s of public health program is described as “a non-thesis, professional development degree” on the website.
It will be either 16 months or an accelerated 12 months in length, and will include six core courses: environmental health, global health, health policy, introduction to biostatistics, introduction to epidemiology, and social and behavioural sciences in public health.
Students will also be able to take elective courses and will participate in a three-month practicum. “Creating a school of public health with a more global outlook would encourage opportunities for students and faculties to ‘engage the world,’” Hoey said.
The program is aimed at professionals but also to students who have extensive experience working in the community. Hoey also sees the possibility of there being collaborative programs with the law school and applied science in the future
The proposed Queen's School of Public Health already has a website up and running, where you can read about the master's program. For now, the school is waiting on approval from the Ontario Council on Graduate Studies, which must accredit the program before it can open.
Ever-controversial Ontario health minister George Smitherman managed to annoy a few people in his short visit to Queen's to announce the new funding. He didn't show his face at the struggling Kingston General Hospital, which was interpreted as a snub by hospital officials and the Kingston Whig-Standard.
Photo: Queen's School of Population & Public Health
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Thursday, August 23, 2007
CMA's resolution-mad meeting: the digested read
The CMA's had a busy week, at its 140th annual meeting in Vancouver.
How busy? Well, they passed 108 resolutions in just three days.
To save you the trouble of having to read through all three days'-worth (see Monday, Tuesday, Wednesday, if you really want to), we here at NRM did the hard work and whittled them down to a nice concise Top 15.
A quick glance at some of these issues can give you a good idea of what are likely to be some of the newsworthy issues in Canadian health politics over the next year (aside, of course, from the widely reported and continuing debate over privatization). We've also provided some suggestions for further reading, in italics.
Top 15 CMA resolutions of 2007:
A) explore tax credits and/or direct compensation to compensate informal caregivers for their work;
B) expand relief programs for informal caregivers that provide guaranteed access to respite services in emergency situations;
C) expand income and asset testing for residents requiring assisted living and long-term care; and
D) promote information on advanced directives and representation agreements for patients. [Crowded hospitals mean patients get tossed out earlier than they used to be, so home care is becoming a more urgent priority.]
Photo: CMA 140th Annual Meeting logo
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Not in our name: pro-Medicare docs blast CMA
Canadian Doctors for Medicare's president Dr Danielle Martin (right) and resident-board member Dr Simon Turcotte, blasted the Canadian Medical Association over its declaration of support for private healthcare at its controversy-laden annual meeting in Vancouver this week.
In their op/ed to Montreal daily Le Devoir earlier this week, Drs Martin and Turcotte wrote:En tant que médecins et membres de l'AMC, nous devons demander à notre association pourquoi elle ne fait pas la promotion de solutions qui accroîtraient l'accès aux soins en fonction des besoins, dans le cadre du régime public, où les ressources médicales sont souvent sous-utilisées? Pourquoi l'AMC maintient-elle sa proposition de pratique mixte et d'assurance-maladie privée, qui auront pour conséquence de drainer hors du système public le personnel infirmier, les techniciens et autres dont il a besoin? Pourquoi l'AMC ferme-t-elle les yeux sur les données probantes, sur les risques que poserait le développement d'un nouveau marché des soins de santé?
Translation, in short: For the public good, doctors must oppose the CMA's recent policy-efforts, which would benefit the well-off and do not address the well-being of the population at large. Policies that threaten to weaken the public system should be rejected.
Au cours de son assemblée, l'AMC aura l'occasion de faire preuve d'une approche plus constructive lors des discussions portant sur les soins à domicile, l'assurance-médicaments et la santé environnementale, de manière à améliorer et à moderniser le système de santé financé publiquement, pour le rendre apte à répondre aux besoins de tous, non seulement des mieux nantis.
Les récentes sympathies de l'AMC pour l'assurance privée et la pratique mixte ne figurent pas à l'ordre du jour des débats en assemblée; leur sort devrait s'apparenter à celui des mauvais remèdes, rapidement rejetés.
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Wednesday, August 22, 2007
Drug diaries: I'll show you mine if you show me yours
Writing on his healthcare implementation and compliance blog , Alignmed, psychiatrist Dr Allan Showalter offered offered kudos to NRM for our recent article about drug diaries (“Drug diaries help patients keep their scripts straight,” Vol 4, No 13, July 30, 2007).
Dr Showalter liked our version of the diary (click here for a printable PDF copy), and shared his own version (above) on his site.
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How to beat RateMDs, Round 2
This flashy little animated ad*, left, has recently begun popping up on leading medical blog KevinMD.com, tempting physicians with the promise of a way to fight back against the much-maligned ratings site RateMDs.com.
The company advertised, Medical Justice, is an American medical malpractice insurance firm that specializes in fighting back against threatened lawsuits by threatening patients with counter-suits. (We wrote about Medical Justice on this blog last month here.)
Medical Justice claims their strategy works:In Florida, physicians are sued at a rate of 15% per year. (FPIC 2004 Q1 statistics, Crittenden)
The company, founded by Dr Jeffrey Segal (right) recommends a three-pronged attack against would-be malpractice litigants: One, deter frivolous lawsuits. Two, warn perpetrators with a strategic Early Intervention Program. Three, prosecute counterclaims when necessary.
Matched by specialty, the overall suit rate for Medical Justice Plan Members practicing in Florida is less than 2%.
Is this merely deterrence or is it intimidation? Depends on your perspective. Patient advocate/website designer John Swapceinski (left), of RateMDs fame, is furious about the company's idea of having doctors ask patients to sign nondisclosure agreements before agreeing to treat them. The idea is that if a doctor proved that all his or her patients had signed such agreements then even an anonymous posting on RateMDs.com would have to be a breach of contract, thus giving physicians ammunition in the fight to remove negative ratings from the website. “I would have a real problem with that and I would try to put up a fight to prevent that from happening,” he told the Wall Street Journal Health Blog.
After that interview, Mr Swapceinski initiated a Medical Justice-slamming discussion on his own website's forum, titled "Medical Injustice." Here are some of his cohorts' responses:"I would personally not be likely to even want to be treated by a physician that was so paranoid about what might be said about them by a patient so as to request that such a document be signed by them. For me, that would be a signal to get the hell out of their office asap and never go back." - JaneQPatient
You can read the Medical Justice press release on their website.
"Provided it was allowed to be implemented (don't know the legalities of it), I can tell you it would work after the first few patients got caught. From experience, its not hard to recognize your patients on the internet. People tend to write the way they talk, and most patients (well, people in general) can't help but divulge personal information about themselves when they write. It would not be difficult to identify a patient that way in many cases." - CanDoc
"So does that mean all doctors will have that?? I don't think my doc even uses a computer!! I know he doesn't have any in his office." - Ms77Doodlebug
*NB: Canadian Medicine/NRM does not endorse the service advertised. Image republished only to illustrate the news story.
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NB doc on trial for arson and drug trafficking, lawyer quits
The lawyer representing Dr Corinna Golding (right), a Rothesay, NB, family physician on trial for arson, uttering threats and narcotics trafficking, has filed for permission to drop her case, reports the New Brunswick Telegraph-Journal today.
Her lawyer, Gary Miller, stated in an affidavit to the court that his relationship with Dr Golding has "irreconcilably broken down [because she has] not fulfilled her retainer obligations in that she has failed to follow our instructions in violation of an express condition of our retainer agreement, which goes to the core of the conduct of her defence."
The Telegraph-Journal reports that no details on that claim are available, but logic dictates that the "violation of an express condition" may refer to recent charges brought against Dr Golding for having contact with a witness in her case -- presumably the young man, Nelson Getson, who was sentenced to six months in prison for the burning of Dr Golding's van. Her arson charge stems from that incident; she is alleged to have paid Mr Getson, the 19-year-old who claims he was her lover, with Percocet pills in exhange for burning the van. (Dr Golding, 41, maintains that he was nothing more than a patient of hers.)
Mr Getson was sentenced to an extra two months imprisonment for having contact with Dr Golding in September 2006 and for having assaulted her the previous month.
Dr Golding's licence to practise was suspended by the NB College of Physicians and Surgeons last September.
Her trial begins on Monday, August 27. She decided to have the case heard by just the judge, without a jury.
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Monday, August 20, 2007
Public health boss blasts Maclean's for HPV 'guinea pig' hysteria
"Our girls are not guinea pigs" declares the front page of this week's issue of Maclean's magazine, citing safety concerns about Gardasil, the human papillomavirus (HPV) vaccine.
The magazine's accusations outraged Dr David Butler-Jones, the Chief Public Health Officer of Canada and head of the Public Health Agency of Canada. He wrote to the magazine's editors last Friday to express his concerns:The morning after Emily Cunningham got a shot of Gardasil, the new vaccine that protects against four strains of the human papilloma virus (HPV) that can cause cervical cancer and genital warts, she woke up with a headache, and neck and back pain. By 9 p.m. that evening in April, she had a fever so high "you could feel the heat rising from her a foot away," according to her mother, Laurie. She was delirious during the night, and the following day couldn't walk without assistance. Bedridden for nearly a week, the 18-year-old from Wyoming missed school, and took Tylenol every four hours. "If Emily had been the only one to get sick we would have said she must have had something else [like the flu]," explained Laurie, "but we know of three other students to have reactions, that is why we are concerned."
Emily's story is only one of 1,637 complaints involving Gardasil, filed as of May to the Vaccine Adverse Event Reporting System (VAERS), a national surveillance database sponsored by the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) in the United States.
Having a healthy debate is essential; however, Dr. Butler-Jones believes that the way Maclean's has approached the issue of the HPV vaccine is inappropriate and one-sided. The suggestion that as public health officials we would support a vaccine that would put the health, or worse, the lives, of girls and women at risk, is irresponsible. The health and safety of Canadians is of paramount importance to me and to public health officials across the country.
The Council of Chief Medical Officers of Health concurred with Dr Butler-Jones. Dr Perry Kendall, chief medical officer of BC (where the vaccine looks set to be administered soon) told the Canadian Press that the article was "alarmist."
Photo: www.petsworld.co.uk
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US Health honcho launches blog - where's Tony?
US Health & Human Services secretary Mike Leavitt (left) has joined the blogosphere.
Our own federal health minister, Tony Clement (right), appears to be behind the times on this one. Will we see a Clementblog any time soon? Only time will tell, though the current government's history of opacity would suggest not.
On the other hand, Minister Clement already has a personal video message available on the Health Canada website in which he strolls through a gym. A sample sentence or two: "Hi! I'm Tony Clement, Canada's Minister of Health, and today I'd like to share with you some 'Food for Thought,' information available to everyone on Health Canada's web site."
He signs off: "I'm Tony Clement. You, stay healthy."
Photo: US Health & Human Services, Mike Leavitt's blog
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Toronto baby's codeine breastfeeding death prompts FDA warning
Following up on the 2005 Toronto death of a newborn from opiate toxicity, the FDA has issued a warning to physicians to limit prescriptions of codeine-containing products to the bare minimum.
The danger is that some women have a genetic mutation that makes them "ultra-rapid metabolizers" of codeine, which becomes morphine and can be passed through breast milk to infants. The case report about the Toronto newborn was published in The Lancet a year ago (subscription required).
NRM covered the issue in our June 15 issue, explaining the science behind the genetic mutation and ultra-rapid metabolizing. We reported on Toronto's Motherisk program's five options for physicians to reduce the threat of injury from codeine in breastfeeding:
- Avoid using codeine in breastfeeding mothers. But this may leave the mother with uncontrolled pain.
- Give the codeine but avoid breastfeeding. No neonatologist, however, is going to recommend stopping breastfeeding at this crucial early stage if it can possibly be avoided.
- Give codeine, but limit concentrations by not giving a high dosage (240 mg/day codeine) for more than a few days. But the Motherisk team worries that this may not control pain adequately, and could still lead to toxic levels of morphine in the milk of ultrarapid metabolizers.
- Genotype all mothers, then limit codeine only in the cases of fast metabolizers — those with two or three 2D6 genes. This is the ideal solution, but unfortunately would be very expensive, and few centres currently have the facilities to do it.
- Use old-fashioned clinical judgement. The mother should be informed of the potential for opioid toxicity, then she and the infant should be monitored closely for danger signs. If symptoms appear, administering naxolone, morphine's antidote, will generally solve the problem and, in doing so, confirm it.
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Friday, August 17, 2007
Alberta supermarket raises cash for DCA research
Strange but true: A Fairview, Alberta IGA supermarket is sponsoring a fundraising drive to help raise money for dichloroacetate (DCA) research.
DCA has been a hot topic since January, when a University of Alberta researcher, cardiologist Dr Evangelos Michelakis, announced that the drug killed cancer tumours - at least in mice. To Dr Michelakis' dismay, desperate cancer patients - believing DCA to be a miracle cure - started experimenting with the treatment. Some have been buying the drug online and using it without medical supervision, as we recently reported. Others have been prescribed the drug by doctors, as in the case of a husband and wife physician team in Toronto that I described in NRM in June.
The Alberta IGA wants to help DCA to go legit. The Fairview Post reports:
The Freson IGA wants to help pay for the next stage of research.
“Cancer has affected at least someone we know. This drug could save lives,” said IGA manager Tom Dunlop.
Eight weeks ago, the store started a program where customers can donate their Smart Shopper cards. Each card is worth 50 cents and is matched by the store.
Since the program started two months ago, the grocery store has raised $900.
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Babes in (American) arms
Karen Jepp thought everything was all ready for her at Foothills Medical Centre in Calgary. After all, it's not like no one knew she was about to give birth to quadruplets.
But when her labour started she and her family were surprised to learn they'd be airlifted to a US hospital for the birth because Foothills didn't have enough beds for all four babies, reported the Globe and Mail. Nor did any other NICU in Canada.
The miraculous identical quads (a one-in-13-million chance, reported the BBC) - named Autumn, Brooke, Calissa and Dahlia (pictured above, with their dad J P) - were all born healthy in a hospital in Montana. The babies were conceived without the aid of fertility treatments.
"We've had an awful couple of weeks. They've been really tough," Ms Jepps told the Globe and Mail. "We're in another country. We're just trying to get through the next few days. We need to get back home." The couple also has a two-year-old son, Simon.
Sending high-risk deliveries to the US has become increasingly common in Canadian hospitals.
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Thursday, August 16, 2007
Nurses host SiCKO junket, drawing senior Grits, but no Tories
A group of senior federal and Ontario Liberal politicians were treated yesterday to a screening of Michael Moore's US healthcare documentary SiCKO by the Registered Nurses' Association of Ontario (RNAO).
Federal opposition leader Stéphane Dion (left), Ontario deputy premier/health minister Mr Smitherman (right) and former Ontario MPP Gerard Kennedy got free tickets to the film from the nurses' association and then sat down to discuss Michael Moore's controversial project.
Prime Minister Stephen Harper and federal health minister Tony Clement - also on the invite list - were no-shows, RNAO executive director Doris Greenspun told the Toronto Sun.
The Toronto Sun kept tabs on the politicians as they watched the movie:Dion was careful to stay quiet during the wait-time segment and sat with perfect posture for Sicko's duration, but afterwards mentioned it when asked if he had any criticisms.
The nurses hosted the screening and debate to remind politicians about the importance of protecting universal health care, but the Liberal Party's PR department put its own spin the event: "Mr. Dion's participation in the roundtable was aimed at soliciting the views of nurses on how best to address the challenges facing Canada's health care system."
"We know that we have awful wait times in this country," Dion said. He said the system in Canada still needs work, even if it looks good against the U.S. model. [...]
Provincial Health Minister George Smitherman, watching in the row behind, laughed at some points before leaving halfway for other business.
Also in attendance was former Liberal leadership candidate Gerard Kennedy, who afterwards called the movie "effective propaganda" but, like Dion, said he enjoyed it.
The Canadian Press also joined the party, calling the event an "unusual political stunt" and quoted Mr Dion saying the film's laudatory depiction of Canada's hospitals was "a bit rosy." "There are strong lobbies that would like to take us there," Mr Dion declared, "but they won't have the ear of the Liberal party."
The CP report dug deeper into Mr Dion's proclamation, however, asking whether Dr Brian Day's privatization-solves-wait-times-problems theory holds water:Dion acknowledged that the private system must have a role in delivering some services - an opinion reinforced by a 2005 Supreme Court decision granting a Quebec doctor the right to provide private for some patients.
We hosted our own roundtable discussion of SiCKO in NRM last month.
"We have to make sure people have speedy access to services while protecting universality (of coverage)," he said.
Photo of Mr Dion: Canadian Press
Photo of Mr Smitherman: NRM
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Wednesday, August 15, 2007
New CMA prez Dr Brian Day already making waves
Dr Brian Day doesn't become president of the Canadian Medical Association until next week, but he's already stirring up controversy.
On Monday, he told the Toronto Star the federal government should put $10 billion or more into reducing wait times across the country -- a task that he believes, as he likes to repeat loudly and often, is best accomplished by introducing an accountability clause to the Canada Health Act and allowing patients to seek care in the private sector if wait-times benchmarks aren't met.
Prime Minister Stephen Harper, since his election last year, appears to have changed his opinion on this debate; he used to advocate greater involvement of the private sector much like Dr Day does now, but after he arrived in Ottawa he has become (outwardly, at least) a more ardent defender of healthcare. The same is true of health minister Tony Clement who seems to be trying to shed his "Two-Tier Tony" nickname.
"[Mr Harper] doesn't understand the financing of the healthcare system," Dr Day scoffed.
Dr Day also appears in this week's edition of the CMAJ, in a friendly interview with Wayne Kondro entitled "A conversation with Dr Day: the joys of notoriety." In the space of several hundred words, Dr Day manages to turn a biographical interview into a mouthpiece for two of his pet projects: patient-focused funding (see Canadian Medicine's recent coverage of the latest news on this) and private delivery of healthcare.
NRM featured Brian Day on the cover last November in a Q&A called "The man behind the melee." He talked about taking the same bus as the Beatles when they were schoolboys, his father's murder, and hanging out with Fidel Castro.
Photo: NRM
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Tuesday, August 14, 2007
Hollywood tackles anesthesia screw-ups
In Awake, a Hollywood film slated to be released soon, Vancouver-born actor Hayden Christensen (right) plays a young husband who regains consciousness during open-heart surgery but is unable to move or talk.
"Anesthesiologists are not looking forward to [Awake] coming out at all," U of T anesthestist Dr Scott Beattie told the Toronto Star. People have become aware of the possibility, he says, and now worry about going under the knife.
Patients' fears, reports the Star, are not entirely unfounded: post-traumatic stress from the experience has led to a myriad of effects, ranging from depression to suicide. In the Star article, one victim recounts her horror when she came to during eye surgery but couldn't warn the doctors. Ms Carol Weirher says her experience left her afraid to sleep or lie down. She spends her nights in a chair, napping for 90 minutes at a time.
Her ordeal prompted her to start the Anaesthesia Awareness Campaign, and she is now fighting to have monitoring devices installed in operating rooms. The device measures brain waves and alerts anesthesiologists when the patient is not completely sedated. It costs between $4,000 and $5,000; only a few are currently available in Canada.
Episodes of intra-operative awareness while under general anesthesia are reported by one or two of every 1,000 patients, writes University of Toronto physiologist Beverley Orser, in June's Scientific American. Most end up going back under, but a few stay conscious enough to feel every cut, pull and tug, yet are too paralyzed by the anesthetic to do anything about it.
An Australian study published in 2005 in the journal Anesthesia & Analgesia found the incidence of awareness during anesthesia for children was about 1 per 125 cases -- as much as four times higher than previously reported rates in adults.
Photo: Awake film still, IMDb.com
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Google Health details leaked
Some details about Google's top-secret health project, codename "Weaver," are trickling out.
The project (see the sample screenshot below) appears to be a sort of EMR for patients, to keep track of treatments, medications, conditions and doctors' appointments. Questions remain about how the information is intended to be put to use, including whether doctors would be able to access patients' files or if patients could send files or reports to their doctors. (The New York Times covered the new developments as well earlier this week.)
Last November, Google VP of Engineering Adam Bosworth described some of the goals of Google Health:"[People] need the medical information that is out there and available to be organized and made accessible to all... Health information should be easier to access and organize, especially in ways that make it as simple as possible to find the information that is most relevant to a specific patient’s needs.”
One EMR competitor wrote in a blog comment that he suspects there's plenty more to come from Google Health:There is something else behind this vanilla data entry application. The functionality represented in these screenflows should not take 1 year and 2 months.
Another Google Blogoscoped blog commenter is wary, however: "Kiss HIPAA goodbye! Hello, Big Brother!!!" (HIPAA is the American equivalent of Canada's PIPEDA information-privacy law.)
I expect something bigger than just this. It's either the tip of the proverbial iceberg, or Goog has not been giving it the attention it deserves.
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Monday, August 13, 2007
Doc's email results in paralysis, lawsuit
Physicians should never give out medical advice by email, however innocuous and casual the conversation may seem, writes New York healthcare attorney Lee Johnson in Medical Economics. Consider this case:In one case, an interventional radiologist gave advice to a 65-year-old woman who had selected the "contact us" option on the practice's website. The woman had written that her doctor recommended a vertebroplasty because radiographs of the lumbar spine showed diffuse osteoporosis and a collapsed third lumbar vertebra. The radiologist responded that he, too, recommended the procedure. An orthopedic surgeon performed the vertebroplasty, complications ensued, and the patient became paraplegic. The resulting lawsuit alleged that the radiologist had "negligently advised" the woman to undergo vertebroplasty "without conducting physical examination and medical testing that would have disclosed the presence of metastatic cancer." [...]
Ultimately, the interventional radiologist mentioned earlier dodged a bullet when the plaintiff's attorney decided his case would be stronger if he focused exclusively on the orthopedic surgeon.
But the lesson remains: When advice is offered via e-mail, a duty may be created and there will be a written record of how that duty was discharged.
I wrote about how physicians can use email safely and effectively in NRM in June. Liability issues are legion, Bill Pascal, the CMA's chief technology officer, told me, but he said there's an even more serious explanation for Canadian physicians' reluctance to use email with their patients:There are very few doctors that are emailing with their patients for one simple reason: most docs are under a fee-for-service structure, and they cant be compensated for providing care through any channel -- patients have to go into the office. The issue is that we don’t have the policies in place that allow [email communications] and encourage it.
I do know [remuneration for email has been discussed] in some of the negotiations between the divisions in the CMA, the 12 regional associations. It is through those levels that negotiations of what gets paid for and not paid for through fee-for-service is negotiated. Up until now, things through the e-channel, as I call it, are not built in. Even telehealth is usually not covered under fee-for-service -- just for people on a salaried basis. One of the things we are looking at now is if we can start to utilize the e-channel in a way that supports care and in a way that doctors and institutions can get compensated for.
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Doctors' self-regulation is dangerous: André Picard
"The failings of Jocelyne Genest, a family doctor and surgeon in Sainte-Agathe-des-Monts, Que., are eye-popping. "According to testimony before a disciplinary panel of the Collège des médecins du Québec, among other things, she: "Performed a sigmoidectomy (a removal of part of the colon) though she was not qualified to do so. Before the operation, Dr. Genest looked up the procedure on the Internet. Not surprisingly, surgery went badly and dragged on for 12 hours, putting the patient at risk for brain damage; "Failed to install a chest drain in a patient suffering from emphysema who was being transferred to another hospital, even though she was told to do so by an emergency room doctor, again putting a life at risk; "Administered 'massive, unprecedented and unjustified' doses of morphine to a terminally ill patient - at the request of a family member, not the patient himself - until he died." "Good doctors make for safer patients. And that is why we must spare no effort in weeding out the bad doctors."
The Globe and Mail public health reporter André Picard (left) argued in a recent column that the long-standing tradition of allowing doctors to police their own profession is hazardous to patients.
In the piece, Mr Picard provides less-than-compelling evidence that there is indeed a need for a change in regulatory methodology. His sample size? One.
Incidentally, the fact introduced two paragraphs later -- that Dr Genest had her license to practise revoked by the College -- doesn't satisfy Mr Picard because she's still permitted to work as a surgical assistant.
Based on the single example, the column concludes:"Right now, we have an inappropriate tolerance for aberrant conduct and deviant practice, and a culture of deference for doctors that serves us poorly.
Inquiries and investigations into all three incidents have been exhaustive. The British system has been significantly reformed since then, and almost all Canadian jurisdictions are now in the process of introducing mandatory relicensure requirements, albeit in a somewhat "watered-down" form compared to what some have proposed.
First photo: André Picard, NRM
Second photo: Court sketching of Dr Harold Shipman, The Guardian
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Friday, August 10, 2007
BC offers hospitals cash incentive to fast track patients
A new hospital funding plan in British Columbia will pay the Vancouver regional health authority extra money for treating patients faster, reports The Globe and Mail.
This is a major departure from the traditional block funding methods used across most of Canada.
The $16.4 million BC plan is just a pilot project for the time being to determine if the strategy works.Starting in October, the B.C. government will pay an extra $100 for every patient requiring hospitalization who is admitted to a bed within 10 hours. There will be an extra $60 for patients who are treated and discharged within two to four hours, depending on the urgency of their needs. Hospitals can use the extra money to expand services, staff and space. In effect, the cash incentive turns the current payment system on its head.
This system, sometimes called patient-focused funding, or PFF for short, is strongly supported by both Dr Brian Day, the new president of the Canadian Medical Association, and Michael Kirby, the former Liberal Senator whose 2002 report on the healthcare system sparked national debate.
"The only way to get people to change their behaviour is by offering them an incentive to change," Mr Kirby told the Globe. "You have to do it with carrots, not sticks."
I wrote about Dr Day's support for the idea in February of this year. But not everybody thinks PFF is going to help:"You have to make sure the incentives you have in place don't get in the way of what you need done," said Raisa Deber, PhD, a University of Toronto health policy expert. "It would be disastrous to move entirely to a service-based funding schedule. That would incentivize overuse instead of appropriate use."
Dr Day explained in a response to my article why he thinks the idea is a good idea:It's no coincidence that the report of Senator Michael Kirby, a PhD in mathematics who applied simple logic and basic internal marketing principles, came out solidly in support of patient-based funding (PFF). In late October of 2006, the updated OECD report also came out solidly in support of it. Of course there must be safeguards in place, and it's not a panacea. Smaller rural hospitals can actually outperform large institutions, although the opposite has been claimed. We're very lucky to have the British experiment to learn from.
One potential caveat, however, may be a paucity of accurate performance measures in Canadian hospitals' reporting, according to a new study published this week by the Atlantic Institute for Market Studies.
[University of Melbourne research fellow Julia Witt] argues it may not always be true that a hospital where patients spend less time is a good hospital.Check out our website: www.nationalreviewofmedicine.com
"Shorter lengths of stay could be the result of insufficient funds or space to keep patients for a more optimal length," she writes.
"If there is pressure on freeing up beds, patients may be released earlier in order to make beds available."
Sometimes, she writes, such "clinical efficiency measurements" assess if a hospital is saving money, but tell little about the quality of patient care.
Ex CMA prez Schumacher joins the private healthcare fray
Windsor family physician Alberta Schumacher (right), former president of both the OMA and CMA, has added his voice to the apparently growing list of Canadian doctors advocating private healthcare delivery, reports the Windsor Star.
Dr Schumacher features prominently in a new National Citizens Coalition (NCC) online campaign called "Face the Facts: Help Cure Canadian Healthcare." He appears in a series of videos on subjects including wait times, human resources, public vs private, and funding issues.
The NCC is staging a series of public consultations, hosted by Dr Schumacher, across the country starting in September.
“The undertaking of this grassroots campaign will remove the political lens that is too often used when studying our national healthcare system,” said NCC president Peter Coleman in a statement released on Wednesday.
Will the NCC really de-politicize the healthcare debate? A better question might be whether that's even possible at this point, or whether groups like the anti-big government NCC are genuinely trying to accomplish that in the first place.
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Thursday, August 9, 2007
Premiers run into some trouble during morning jog
Gary Doer of Manitoba, Shawn Graham of New Brunswick and Rodney MacDonald of Nova Scotia got up early Thursday morning to go for a run in the rain before Council of the Federation meetings in Moncton, NB.
But it wasn't long before protesters, including Canadian Federation of Nurses Union president Linda Silas, stopped them in their tracks to lecture them on healthcare, the environment, labour mobility and trade, reports the CP. (The three runners apparently "sprinted ahead of protesters" before halting.)
CP reports that Premier Doer offered to "support their cause and wear the same hat," referring to the nurses' Medicare caps.
Given that it was raining in Moncton that morning, was his offer genuine - or was he just looking for a way to avoid getting all wet? This morning's report offers no clues, but Ms Silas, who is in Moncton to urge the provincial leaders to protect Canada's universal healthcare system, was left high and dry by the impromptu roadside pow wow: "I don't think they understand the urgency," she said.
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Smitherman ties the knot, but Dalton's a no-show
George Smitherman, Ontario's divisive deputy premier and health minister, took a break from campaigning long enough to marry his partner Christopher Peloso last Sunday.
Premier Dalton McGuinty was invited but didn't make it to the ceremony in Elliott Lake, Ontario; he had a "personal scheduling conflict," his office told CTV News.
"I've got nothing but the best of wishes for George and I'm hoping that this marriage will help him come out of his shell," Premier McGuinty quipped to reporters prior to the wedding.
"[H]e wasn't able to," Minister Smitherman said to the Toronto Star. "He worked hard on his schedule [but Elliot Lake] is a hard place to duck into – to drop in for the ceremony and head somewhere else."
Mr Smitherman, 43, is Ontario's first openly gay MPP. Mr Peloso, 33, a Lindt Canada manager, and he had been dating for 18 months. Mr Smitherman proposed at Christmastime by giving his partner a tuxedo with a wedding invitation in the pocket.
Part of the ceremony was conducted by Ojibway spiritual advisor Ron Indian-Mandamin, who, according to the Star, "referred to the ancient concept of gay or 'two-spirited people' who in generations past often served as tribes' mystics or medicine men."
Mr Smitherman, backing down from a claim he made in the Ottawa Citizen earlier this year, showed up in a blue suit instead of a thong. (See sidebar, right, to read what he told me in April about getting ready for the wedding.)
The NRM Award for the Best Smitherman Headline Ever goes to UK-based gay news service Pink News: Political bruiser shows softer side on gay wedding day
Photo: George Smitherman, in blue, and husband Christopher Peloso, in white; Toronto Star
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Weed spray ok'd for cancer pain
Health Canada has approved the cannabis-derived pain-reliever Sativex for neuropathic pain in advanced cancer patients. The drug, sprayed under the tongue, is intended as a therapeutic adjunct, for patients who haven't had decent relief with opioids.
Pot-based drugs are seldom used (legally) for medicinal purposes outside of clinical trials, and Canada is leading the pack in terms of access to it. Sativex is already available in the UK and Spain, although access in those countries is tighter than here.
Depending on your viewpoint, you'll be relieved or disappointed by the manufacturer's insistence that Sativex doesn't offer the psychotropic effects pot-heads typically seek, reports the Wall Street Journal Health Blog. I'm not sure how that works, considering Sativex contains THC, the main psychotropic compound in marijuana. At any rate, at $125 per vial, Dr Allan Gordon of Toronto’s Wasser Pain Management Centre at Mount Sinai notes that it wouldn't the most cost-efficient way to get high.
Canadian pain docs are pleased to have another drug option in their arsenal. "There's an unmet need there and finally we're seeing some attention being paid to the problem," Dr Gordon told the Globe and Mail.
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Dr Charles Smith inquiry gets underway
Embattled pediatric forensic pathologist Dr Charles Smith (right), who allegedly put a number of innocent people in jail after he gave inaccurate testimony as an expert witness in 20 cases in Ontario from 1991 to 2001, is the subject of a provincial inquiry ordered by premier Dalton McGuinty.
Eleven individuals or groups -- including Dr Smith himself -- have registered with inquiry commissioner Justice Stephen Goudge to testify at the hearings.
According to a Canadian Press report, the inquiry has a broader scope than just looking at Dr Smith:
The inquiry will examine the state of pediatric forensic pathology in Ontario and its practice and use in investigations and criminal proceedings between 1981 and 2001.
While the inquiry will examine the cases individually, Goudge has said he will not "correct errors in specific cases," provide financial compensation to any victims, or offer any conclusions or recommendations regarding discipline or criminal liability.
Instead, he will use the individual cases to determine what systemic issues they raise and will then make recommendations to restore public confidence in the pediatric forensic pathology profession.
The inquiry will submit recommendations to Ontario's attorney general by April 25, 2008.
You can read about the Dr Smith case in this NRM article from last year. The CBC profiled Dr Smith in April, as did the Star. A lawsuit was launched in Ontario against him in May, reported the Toronto Star.
Photo: CBC
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Wednesday, August 8, 2007
AMA turning blind eye to 'medicalization of torture': Harper's
Or should we say "enhanced interrogation," to use the new US administration parlance.
A commentary in the August issue of Harper's Magazine looks at a claim by the US's director of national intelligence Admiral Mike McConnell on NBC's Meet the Press that "enhanced interrogation techniques" used on prisoners are conducted "under medical supervision."
In the commentary - provocatively entitled "The Ongoing Medicalization of Torture" - Harper's senior editor Luke Mitchell reports that he tried to get the American Medical Association (AMA) to comment on the claim and asked if they'd investigate the doctors who are taking part in the "enhanced interrogation." After dismissing the claim as a psychologist/psychiatrist mix-up, common among non-physicians, the AMA finally told Mr Mitchell that it has no plans to investigate the allegation that its members are involved in torture.
This seems strange since, a year ago, the AMA released ethical guidelines that prohibit doctors from participating in interrogations:"Physicians must not conduct, directly participate in, or monitor an interrogation with an intent to intervene, because this undermines the physician’s role as healer."
Meanwhile, a new investigation into the US government's insistence that "enhanced interrogation" does not constitute torture by Physicians for Human Rights and Human Rights First concludes the the government's got it all wrong. Dr Scott Allen, co-author of the report and co-director of the Center for Prisoner Health and Human Rights at Brown University said in a release August 2:"These 'enhanced' interrogation techniques can cause severe and often irreversible harm to their victims. The report's full and independent review of the medical literature and case studies concludes that these methods are likely to cause significant physical and mental harm to detainees, and they should be immediately and explicitly prohibited by the Bush Administration and by Congress."
Added Human Rights First's Elisa Massimino:"The Administration's argument that doctors will oversee the program to ensure that interrogators don't go too far gives new meaning to the term 'calculated cruelty'."
Photo: A prisoner at Abu Ghraib - torture or 'enhanced' interrogation? (BBC)
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Medicare defenders roll out Trojan Horse
A five-metre tall, wooden Trojan Horse is travelling across Ontario, accompanied by representatives of the Ontario Health Coalition.
The pro-medicare lobby group composed of healthcare union members says the stunt is a reaction to the provincial Progressive Conservative party's idea of introducing public-private partnership (P3) hospitals to Ontario. Like the Greeks' equine "gift" in Homer's Iliad, P3 healthcare will wreak unexpected and total havoc on medicare, argues the Coalition.
The Coalition's website expounds on the statue's symbolism:Like the fortified walls of ancient Troy, a powerful national consensus has so far protected public health care from attempts to privatize it. P3s are packaged to circumvent these poweful defenses by deception. A giant five metre Trojan horse representing the devious plans to privatize health care via the P3 model has been crossing Ontario, drawing attention to the Conservatives' privatization of health care by stealth and the McGuinty Liberals' weak position on the issue.
What does the public think of the giant, wooden statue parked on hospital lawns from Kenora to Kingston? The Sudbury Star reports:Laurent Nault, who works at Sudbury Regional Hospital's Memorial site and is a chief steward with CUPE 1623, said public reaction to the Trojan horse and its message was good.
The campaign is intended to raise public awareness of threats to the public healthcare system in anticipation of the October 10 Ontario election. As they travel with the horse the Ontario Health Coalition is handing out pamphlets to local residents. "[H]opefully they will make their decision on the information," Nault told the Star. "We will give them the facts."
"We've got people honking their horns," he said. "People are fully aware of the Trojan horse story." 
The Coalition might first want to check those facts. The Trojan horse never existed. Turns out Homer likely invented it to represent Troy's destruction by earthquake in 1250 BC. Poseidon was god of the seas as well as earthquakes, was often associated with horses, according to National Geographic in its exposé of the 2004 Brad Pitt film "Troy," which would explain where Homer got the idea.
The war and the huge, fake animal made for a better story, apparently.
Describing a healthcare policy as a Trojan Horse is nothing new:
- US Democratic presidential hopeful John Edwards's healthcare platform includes a "laudable" Trojan Horse that could undermine private insurers' plans and introduce greater government-financed healthcare, wrote Timothy Noah of Slate last month.
- On the other side of the political spectrum, in 2005 an American blogger called then-Arkansas governor and current Republican presidential hopeful Mike Huckabee's requirement to measure schoolchildren's BMI a Trojan Horse that could lead to wider, "intrusive" government involvement in healthcare.
- In California, Arnold Schwarzenegger's universal coverage plan was recently accused of being a Trojan Horse that would increase the price of health insurance premiums for families.
- Wal-Mart's announcement last year that it would participate in a "big employers" EHR plan is a "perfect" Trojan Horse that could improve American health delivery overall, wrote a University of California at Berkeley School of Information professor.
- And, last but not least, Ralph Klein himself is a Trojan Horse, according to a 2005 book put together by the University of Alberta's Parkland Institute.
First photo: Thunder Bay Chronicle Journal
Second photo: "Troy" movie still
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