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Friday, February 8, 2008

Docs to blame for Heath's drug death?

The tabloids are really mad at doctors.

Red tops of the world are blaming the medical profession wholesale for prescribing the cocktail of lethal drugs that killed actor Heath Ledger on January 22. "Doctors doomed Heath Ledger with prescription drugs" screamed Australia's Daily Telegraph.

The painkillers oxycodone (aka hillbilly heroine) and hydrocodone, and the anti-anxiety drugs diazepam and alprazolam were found in Mr Ledger's system. His death has been ruled an accident.

An "investigation" into who was responsible for writing the scripts is now underway by the New York Drug Enforcement Administration. No word on how long looking at the doctor(s)' names on the pill bottles will take.

We all loved his star turn as the muttering gay cowboy in Brokeback Mountain, but can the sweet sorrow associated with this "bright young talent snuffed out" (as William Shatner put it) really blind us to the fact that poor judgement may have been to blame? (Er, check out those red sunglasses.)

Happily, the bad rap doctors are getting from the scandal sheets is not stopping them from weighing in on the case - especially to defend their profession. "No doctor would prescribe that cocktail," opined Dr James Zacny of the University of Chicago's Department of Anesthesia and Critical Care to the Telegraph. "It doesn't make sense that one doctor would prescribe all those," agreed Dr William Lee, a Dallas internist in the same paper. "It's more likely that he got them from different prescribers."

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Canadian doctors in the news

Canadian physicians are keeping busy these days, with bylines in a number of newspapers across the country.

"Why I'm an abortion doctor" by Dr Garson Romalis, The National Post, Feb 4

"I remember one 18-year-old patient who desperately wanted an abortion, but felt she could not confide in her mother, who was a nurse in another Vancouver area hospital. She impressed on me how important it was that her termination remain a secret from her family. In those years, parental consent was required if the patient was less than 19 years old. I obtained the required second opinion from a colleague, and performed an abortion on her.

"About two weeks, later I received a phone call from her mother. She asked me directly 'Did you do an abortion on my daughter?' Visions of legal suit passed through my mind as I tried to think of how to answer her question. I decided to answer directly and truthfully. I answered with trepidation, 'Yes, I did' and started to make mental preparations to call my lawyer. The mother replied: 'Thank you, Doctor. Thank God there are people like you around.'"

Dr Romalis's article, which is a transcript of his speech to the late-January University of Toronto Law School conference on the 20th anniversary of the Morgentaler decision, goes on to detail not one but two attempts on his life: a 1994 shooting and a 2000 stabbing.
"Why I'm not an abortion doctor" by Dr Paul Ranalli, The National Post, Feb 7
"I happen to disagree with what they are doing. I also condemn the personal threats and attacks on them by a radical few whose actions are the antithesis of promoting life and have left a blot on the mainstream pro-life movement. This is a blot that abortion advocates — and their supporters in much of the media — have exploited repeatedly to try to silence the reasonable moral arguments against abortion and its unrestrained practise in Canada today."
"A soldier's final moments" by Dr John Ross, The Globe and Mail, Feb 6
"The soldier is surrounded by monitors, IV lines and postoperative dressings. He was the victim of a bombing outside Bagdad and had suffered a blast injury and severe burns. His face looked like melted wax, no recognizable features. An endotracheal breathing tube comes out of what was once a mouth.

"His buddy, who had been on the same patrol, lies on the bed ahead of him. A medic and nurse try to protect him from the fate I had just witnessed."

Dr Ross's article, which he discussed with the Halifax Daily News yesterday, calls to mind the long piece by BC internist Kevin Patterson in the American magazine Mother Jones. That piece, "Talk to me like my father," has brought no end of trouble to Dr Patterson, who has nevertheless continued to publish. He is editor of a new book called Outside the Wire, which features writing by Canadians who have served in Afghanistan (and an impressive forward by Romeo Dallaire) and he has a new article coming out in the April issue of The Walrus titled "Diseases of affluence."
"Our strange indifference to aboriginal addiction" by Dr Gabor Maté, The Globe and Mail online, Feb 5
"Marlene, a 46-year old native woman, sat in my office last week, slumped on her chair, blinking away her tears. I'd just shared the news that her most recent blood test confirmed she had 'seroconverted' to HIV, become infected with the AIDS virus. Although an injection drug user, Marlene had always been careful to use clean needles. Her route of infection was sexual contact — with the resigned naiveté characteristic of so many aboriginal women in Vancouver's Downtown Eastside, she had trusted a man, himself a drug addict, who assured her that he was a safe partner."
In the article, Dr Maté calls for Canada to apologize for its treatment of aboriginal peoples, like it did for its imprisonment of Japanese-Canadians during World War II. Dr Maté's latest book, In the Realm of Hungry Ghosts, about his experience treating addiction in Vancouver, comes out next Friday.
The Walrus's March issue (not yet fully online) has an interesting short article in the Field Notes section about Dr Aden Ismail, a Somali-Canadian psychiatrist, visiting Somaliland's only mental health facility.

"Family doctor shortage: more than lifestyle demands" and "Move forward with primary care reforms" by Dr Preston Smith, Moncton Times and Transcript, Jan 31 and Feb 1
A two-part op/ed on primary care reform in New Brunswick.
"Deciding when life ends" by Arthur Schafer (not a doctor; he's a philosophy and ethics professor at the University of Manitoba), The Ottawa Citizen, Feb 8
"At the end of the day we may all be forced to accept some fundamental truths: death is inevitable; health care resources are limited; health care professionals have an obligation to steward those resources; and patients and their families must try to understand what a modern health care system can realistically offer."

We have an article in NRM this month about the same subject: "Who decides DNR cases -- docs, families, judges?" You can read it on our website when it's published online later today.
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Thursday, February 7, 2008

Vasectomies by Dr Dick Chopp, and more physician aptonyms

Dr Richard "Dick" Chopp performs vasectomies at a urology practice in Austin, Texas.

That's not a joke. Dr Chopp is one of a number of physicians whose names describe their line of work -- often humourously or ironically. There are so many examples of this, in fact, that University of Lousville onomastician Frank Nuessel devoted several pages of his 1992 "The Study of Names" to this kind of name, which he calls an aptonym (also called aptronym).

Physician aptonyms were recently the subject of an article in the American Medical News. Alongside a handful of other amusingly named physicians, Dr Chopp makes an appearance:

"My patients call me Dick Chopp. They say, 'How did you get that name?' 'I say, 'It's mainly divine intervention.'

"It's always been fun for me. Everybody wishes they had my name."
He even gives out T-shirts to vasectomy patients. On the back, they read "I was 'chopped' at the Urology Team." Classy.

Dick Chopp isn't the only doctor with a medically appropriate (or inappropriate, as the case may be) moniker -- there are plenty more, including a few Canadians as well.

PHYSICIAN APTONYMS
  • Dr John Looney, adolescent psychiatrist, Durham, NC ("Psychiatric patients are coming in a state of unhappiness," he said in the AMNews article. "They really don't care if your name is Joseph Stalin as long as you can related to them and you're warm to them.")
  • Dr Barret Hyman, obstetrician/gynecologist (source)
  • Dr Joseph C Babey, pediatrician (source)
  • Dr Eric M Knapp, anesthesiologist (he's actually a dental surgeon, not an MD)
  • Dr Dwain Illman, emergency medicine specialist, Indianapolis, IN (source)
  • Dr Stephen Tredwell, orthopedic surgeon, Vancouver, BC (source)
  • Dr Ritchie A L Younger, cosmetic surgeon, Vancouver, BC (source)
  • Dr Thomas Payne, Baton Rouge, LA ("The hardest thing is to try to laugh and make them think they're the first one to say something," he told AMNews. "I tell them my first name is Less.")
  • Dr Kevin Blinder, retina surgeon, St Lousie, MO (A mentor once demanded he change his name before they co-published research, but he demurred. "My father would have been upset," he said.)
  • Dr Robert Stubbs, genital cosmetic surgeon (including circumcisions, naturally), Toronto, ON (He learned his circumcision technique from a Chinese physician named Dr Long.)
  • Dr David Butcher, GP, Prince George, BC (source)
  • Dr D'Eath, surgeon & his partner, the anesthetist Dr Coffin (New Scientist)
  • Dr Aikenhead, allergist (source)
  • Dr David Hart, cardiologist, Columbus, Ohio (source; and he's not the only Dr Hart cardiologist)
  • Drs AJ Splatt and Dr D Weedon, urologists, Britain (source)
Mari Stoddard, a medical librarian at the University of Arizona, has a fantastic list of physician aptonyms -- too many to list here -- on her website. Some are almost too good to be true, I think. A respirologist named Dr Pipe? An infertility specialist named Dr Blank? A urologist named Dr Alden Cockburn?! But Ms Stoddard claims they're all real. There's another good list, which overlaps with Ms Stoddard's, here.

NOMINATIVE DETERMINISM
Is it possible the doctors listed above were destined, because of their names alone, to become physicians?

Some have suggested that people with aptonym names are in fact examples of a theory called "nominative determinism." (There's an admirably straight-faced article on Wikipedia on this subject, including a section on Jungian synchronicity. I'm a bit puzzled about that one; isn't synchronicity acausal by definition?)

It sounds crazy, yes. But can you imagine John Tory as a Liberal or New Democrat? I didn't think so.

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Wednesday, February 6, 2008

Smackdowns and touchdowns for Quebec's private healthcare pioneers

A trio of momentous private health happenings this past week saw Quebec's health minister Philippe Couillard (right) flex the muscles of his province's landmark private healthcare legislation, Bill 33.

The government is keen to expand private delivery, but only what it's defined as allowable under its very narrow definition. Any operators who fly too close to the sun (ie charge patients for access to public doctors) - including the man who made it all happen, Dr Jacques Chaoulli - are swiftly slapped down. Here's the lowdown:

1. P3 DAY SURGERIES ROLLED OUT
Today, Montreal private surgery clinic Rockland MD performed its first operation on behalf of the public Sacré-Coeur Hospital. The deal was struck between the clinic and the provincial government months ago to address surgery waits at the hospital due to OR nursing shortages, but only just got off the ground. Under the deal, Sacré-Coeur will rent two ORs (including all equipment and nursing staff) two days per week. two days a week. The contract is for $450,000 contract, which works out to about $9,000 a day, according to The Gazette.

2. CHAT UP A DOCTOR
Meanwhile, another Quebec private healthcare venture - this one based in Quebec City - is raising eyebrows at the ministry. A group of physicians announced they will launch Myca, an online medical practice where patients can have a live internet "chat" with a doctor, later this year. Patients will pay a joining fee of $10 and then $50 for the privilege of Instant Messaging with a doctor within three hours. "This is not aimed at complicated cases, but rather at minor cases or followups for chronic illnesses," said Dr Yves Dugre, Myca medical affairs vice-president Yves Dugre, a former head of the Quebec federation of medical specialists (which went through acrimonious contract negotiations with the government in 2006).

"It also raises a lot of ethical questions," Isabelle Merizzi, spokeswoman for Dr Couillard, told The Gazette. "If those doctors have the time to go on the Internet to see patients, why don't they spend more time in the universal public health system instead?" The ministry plans to investigate the legality of the scheme.

3. DR CHAOULLI LICKS HIS WOUNDS
Speaking of which, the third momentous health event in Quebec involves the legality of a business model launched by the always-controversial Dr Jacques Chaoulli. You'll remember Dr Chaoulli's landmark case against the Quebec government's ban on private health insurance for publicly-insured services. His win in 2005 set the stage for Bill 33. (We featured Dr Chaoulli on our front cover in December 2006.)

He reappeared last year with a new idea called the Chaoulli Group. The medical brokerage firm facilitated quicker access to a doctor - for a fee. Quebec's health insurance department, RAMQ, ruled on February 1 that he wasn't breaking any rules - but only because Dr Chaoulli backed down and said doctors who still work in the public system will not be paid directly by patients nor will they receive a commission from the Chaoulli Group. Dr Chaoulli insists the concept will go on, despite its diminished appeal for doctors. "There is no problem with my company," he told The Gazette. "It's not bankrupt."

I asked Health Minister Dr Philippe Couillard what he thought of the Chaoulli Group when I interviewed him in December (his sentiment here may sound familiar):

"It's always surprising to me to see that doctors say they have no room to take more patients but surprisingly enough when there are broker systems like this offering money to see new patients they seem to have enough room. I find that quite paradoxical. I pointed this out to my partners in the medical federations and they basically agreed with me that it's a rather embarrassing situation."
He also told me that though doctors seem to be in favour of a system that would allow them to work in both the public and private systems (something he's strongly opposed to), when push comes to shove, he doesn't think they'll go for it :
"There was a fundamental pact that was made when the Canadian healthcare system was developed in the 60s and 70s, that the doctors would only work in the public sector but in exchange would keep their freelance status and have an income that would be on average equivalent to what they would get if they were doing dual practice. If we want to go back and look at this again, a lot will have to change, including the way and how much doctors are paid in the public system. I'm not sure Canadian physicians want to go that way."
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In long-running New Brunswick trauma system spat, Saint John bests Moncton

The New Brunswick government has finally ended nearly two years of speculation and suspicion by awarding the top trauma care designation in the province to the Saint John Regional Hospital rather than a hospital in Moncton.

Health Minister Michael Murphy today announced the trauma level ratings for 18 hospitals across the province. The Saint John Regional Hospital (pictured above) earned the province's only Level 1 designation, while the Moncton Hospital was deemed the only Level 2 facility.

The argument between the two cities began after an 18-hour delay caused by confusion over the correct course of action nearly killed 67-year-old Tracadie man Donald Thomas, as NRM reported last year. In a bitterly ironic twist, Mr Thomas had been driving to the hospital to visit his wife when he was severely injured in a head-on collision.

Tracadie's small community hospital didn't have the facilities to deal with such a case; doctors in larger Moncton, 200km away, refused to take him, advising he be sent to Bathurst instead. Mr Thomas languished there for 12 hours with very severe injuries. He was nearly sent to Halifax (460km away) because his doctor, a Quebecer who was new to NB, wasn't aware that Saint John even existed (the city is often confused with St John's, Newfoundland) let alone had an accredited trauma centre. Luckily for Mr Thomas, when they called Halifax to arrange transfer an incredulous hospital staffer there said "Take him to Saint John!" (370km away). He was eventually transferred there and operated on.

Mr Thomas went public with his harrowing ordeal and then-health minister Elvy Robichaid commissioned a report into what went wrong. The report — details of which were released in April 2006 — by Dr Isser Dubinsky, a veteran Toronto-based healthcare consultant, contained a whole lot of criticism about the way trauma care was being handled in the province — and some 29 recommendations. Among them, Dr Dubinsky recommended a dedicated trauma centre (the cause of the current debate), more personnel devoted solely to trauma and better air ambulance service.
There were suspicions that Mr Murphy would award the top designation to a Moncton hospital; that's his riding. Some experts proposed that the job of coordinating trauma care be split between Saint John and Moncton, but another report from 2007 dismissed that idea.

The debate touched on the always-touchy language question. Moncton, a thoroughly bilingual city, was said to be a better option (its more central location was cited, as well).
As Canada's only officially bilingual province, nearly all political debates in New Brunswick touch upon the language issue. Some have argued that Saint John, a primarily English-speaking city, is a less appropriate site for a province-wide trauma centre than bilingual Moncton. [Dr Andrew Trenholm, surgical director of the Saint John Regional Hospital] dismisses this out of hand. "It's a non-issue," he says. "The Medical Services Act of New Brunswick states that you have to be able to offer treatment in both official languages in any hospital and I would say we do an extremely good job at this here in Saint John." He says his former patient Mr Thomas, a francophone, would attest to that. In fact, Mr Thomas, who lives considerably closer to Moncton, is so passionately advocating that the SJRH be named the provincial trauma centre that he's threatened to sue the province if they decide otherwise. "I think it should be Saint John because of the spirit in which the Saint John Regional Hospital was instituted," he told the Telegraph-Journal.
It remains to be seen whether the government, or Mr Murphy himself, will feel any blowback from what may be perceived as a snub of Moncton.

According to today's announcement, the Saint John Regional Hospital will also serve as "the co-ordinating centre for planning purposes for the provincial trauma system." The announcement also establishes an on-call list to keep track of trauma specialists, a registry of cases and a trauma hotline, reports the CBC.

For an explanation of what the different ratings -- Level 1 through Level 5 -- mean, see Section III of the Trauma Association of Canada accreditation guidelines (PDF).


Photo: New Brunswick Museum

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Doctors must kill the skunk, says bioethicist

When Toronto neurosurgeon and bioethicist Mark Bernstein encountered a wounded skunk in the middle of the road on his drive to work, he considered his options.

I figured I had four: 1) I could stop and pick it up and drive to an all-hours veterinary clinic (I knew the whereabouts of one due to a recent illness in one of my two Labradors); 2) I could keep driving and forget about it; 3) I could call 911 or information to get a number for the humane society (assuming they have an after-hours number); and 4) I could try to somehow put the poor thing out of its misery.
You can probably guess where this story is going.
I put the car in drive and slowly drove over the poor beast in my heavy Toyota four-runner truck. I felt the front wheel roll over the animal and a second later the back wheel. I stopped a few yards away and stared back for a good five seconds and it remained motionless. I was satisfied I had done the job but for good measure, I repeated the process twice more. I then proceeded down to work, driving slower than usual, deep in thought and feeling a little nauseated, but convinced I had done the right and kind thing.
In his article "Curbside Ethics" (PDF, pp 3-4) for the Joint Centre for Bioethics newsletter this month, Dr Bernstein explains why his decision is the only one an ethical physician can make. The dying skunk on the road isn't just a skunk -- it's a metaphor for the entire field of medical ethics.
Sometimes in life we have to do unpleasant things, but must take comfort in knowing we felt it was the right thing. Exercising “tough love” with a child with major problems such as drug abuse would be one example. Another would be kicking a child out of the house when you feel they have overstayed their welcome and their life is not going forward because of their desire to stay in the protection of their parents’ womb. A further example would be a doctor reporting to a family an error performed in the course of well-intentioned caring for a patient. Another would be breaking the heart of a 29-year old woman, wife, and mother by having to inform her that the brain tumour you have just removed is highly malignant. Maybe these aren’t exactly analogous, but you get the idea. Sometimes you need to do something difficult, then go forward knowing you did your best under the circumstances. There are countless examples in our everyday lives. We can go though life hoping that we never encounter such ethical real-life dilemmas, but we’re kidding ourselves if we believe we will be that lucky.
Would you have killed the skunk? It's an important question -- one that physicians would be well advised to consider.

There's the easy solution: ignore the skunk (i.e. dismiss the noncompliant patient; rush through the diabetic comorbidities cases; let patients stay on narcotic painkillers as long as they claim to 'need' them; or any other manner of unpleasant tasks).

And then there's the hard one: kill the skunk.

Physicians must be prepared, says Dr Bernstein, to crush the skunk repeatedly beneath the tires of trucks.


Photo: MontanaPictures.net

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Clement jokes about NDP health concerns

NDP health critic Judy Wasylycia-Leis found out yesterday what you get when you ask the Minister of Health about perceived violations of the Canada Health Act. (I'll give you a hint: it's not a serious, considered response.) The following is the transcript of a brief exchange Tuesday afternoon between Ms Wasylycia-Leis and Conservative Health Minister Tony Clement (pictured above). I've marked the salient comment in red, below.

Ms. Judy Wasylycia-Leis (Winnipeg North, NDP):
Mr. Speaker, all across Canada public health care advocates are sounding the alarm. There is for profit surgery in B.C. There is privatizing home care in Ontario and soon to be duelling systems in Alberta and Quebec.

Yesterday CUPE and Canada's nurses were forced to release a how-to book on defending medicare and launched a national campaign to inform Canadians about their health care rights.

Does the Minister of Health agree that the health care system in Canada must remain 100% publicly funded and operated?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, the position of this government and this party is clear. We support the five pillars of the Canada Health Act, which include universality, accessibility and affordability. We have acted to ensure better access.

The Liberal members are barracking right now. When they were in power, the wait times doubled in the country. We have tackled wait times with the provinces and territories. We put the focus on the patient. We are very proud of that record.

Ms. Judy Wasylycia-Leis (Winnipeg North, NDP):
Mr. Speaker, there is something wrong when we cannot get the government to stand up and defend medicare. I suggest the Minister of Health start listening to P.E.I. health coalition activists, who say that islanders are getting ripped off at the hospital.

Residents of P.E.I. must pay for ambulance service, physiotherapy, medically necessary cosmetic surgery, diagnostic tests and new medications not yet approved. The Prime Minister's so-called wait time guarantee has not made wait times in P.E.I. go down at all.

Does the minister at least agree with the suggestion that Canada needs a Health Act ombudsman and an appeal process?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, she and I at least share one thing, diminutive statures. I was standing up for medicare. Perhaps that was not noticeable where she is in her part of the House.

We do take this seriously. That is why our focus has been on the patients. That is why we have worked with the provinces and territories to ensure health care is a priority for this government and our future governments as well.

(Reprinted from the House of Commons Hansard for February 5, 2008.)
Yikes. I guess that's a resounding "no" to the idea of a Canada Health Act ombudsperson and appeals process -- which, incidentally, seem like entirely reasonable suggestions given the fact that the federal government has had to penalize provinces by withholding portions of federal transfer payments a number of times for CHA violations.

Want some more of that Tory wit? Tony Clement is featured in a Q&A on the cover of the new issue of the National Review of Medicine.

Photo: Ashley Fraser, NRM


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Tuesday, February 5, 2008

Healthy lobsters, hungry mice, sweaty nurses and much more from across Canada

Catch up on all the goings-on in Canadian health politics news with our latest installment of Across Canada, an overview of medical news from coast to coast to coast.

British Columbia
No gender equity in cancer tests
VANCOUVER -- Cancer screening need not be provided equally to men and women, according to a January 17 BC Human Rights Tribunal decision (PDF). Victoria lawyer Laurence Armstrong complained men were being discriminated against by the government's policy to pay for cervical and breast cancer screening for women, but not for prostate cancer screening for men. The tribunal ruled prostate specific antigen (PSA) testing is not clearly beneficial for asympomatic middle-aged men, agreeing with the position of the Canadian Cancer Society.

Alberta
Canada gets its first HeartNet
CALGARY -- Calgary woman Maggie Thiesen recently became the first Canadian to receive a HeartNet, an experimental metal “sheath” to control the size of cardiomyopathic patients’ hearts. Drs Paul Fedak, Debra Isaac and Jenagir Appoo implanted the device through a tiny opening in Ms Thiesen’s chest in just one hour in a January operation at Calgary’s Foothills Hospital. The procedure is part of a study of the HeartNet implant being conducted by physicians in Montreal, Vancouver, Calgary and the United States.

Saskatchewan
Health admin faces drug charges
SASKATOON -- A senior government health official has resigned after he was arrested for allegedly operating a major drug ring. Police caught 54-year-old Saskatoon Regional Health Authority board member Eric Braun, who is also involved in the local theatre scene, with over $200,000 in illegal drugs in mid-January, including marijuana, cocaine and psychotropic mushrooms. Health Minister Don McMorris pledged not to remove Mr Braun from the board unless the charges were proven, but Mr Braun resigned beforehand.

Manitoba
Nurse doctored his credentials
WINNIPEG -- A Winnipeg nurse has been fired after he was found to have worked at Seven Oaks General Hospital for two years with forged credentials. Eduardo Canseco, a Philippine immigrant, also worked in longterm care and youth addiction treatment centres and has been praised by colleagues as an “excellent” nurse. Mr Canseco is now under investigation by the police, the government and the nurses’ regulatory body. Mr Canseco told recruiter Mike Vasilica that he was an RN in the Philippines and had passed his RN exam in Manitoba.

Ontario
Neighbour accused in FP’s murder
LION’S HEAD -- A neighbour of Dr Henry Janssen, a 57-year-old family physician murdered January 22, has been charged. Wayne Powney, 63, was taken into custody by police two days after Dr Janssen, who served as a site chief at two local hospitals, was discovered in his truck, killed by a gunshot. Dr Janssen passed up a career in the Canadian Football League to attend medical school after he was drafted third overall by Calgary in 1974.

MD pays again for birth defects
TORONTO -- Parents of twins born prematurely with birth defects after Sault Ste Marie obstetrician Paul Hergott prescribed the fertility med clomiphene citrate have been awarded a further $3.5 million in damages by an Ontario Superior Court judge. Dr Hergott was previously ordered to pay them $5.1 million before the appeal. Dr Hergott’s defence rested on having the case heard as a ‘wrongful life’ suit (a first in Ontario history), but the prosecution successfully argued “the [clomiphene citrate] caused the twinning, the twinning caused the prematurity, and the prematurity caused the damage.”

Quebec
Sweaty nurse’s firing OK: gov’t
QUEBEC CITY -- The dismissal of a 300-pound-plus nurse on the grounds of her excessive sweatiness was upheld by a provincial labour tribunal in January. The Outaouais Valley Hospital Centre, which fired the nurse in 2005, argued that her perspiration in the operating theatre increased the risk of bacterial infections. The Interprofessional Healthcare Federation union argues the nurse’s obesity should be seen as a medical condition and a handicap.

New Brunswick
Doctor versus mice
MONCTON -- Dr Denis Allard has declared war on a gang of ravenous field mice that have invaded the produce and baked goods aisles of a Moncton grocery store. Dr Allard, a public health official, is overseeing the destruction of the store’s cakes, bread, vegetables and other mouse-infested products. He told CBC News the mouse droppings are unlikely to cause major illnesses. “I think it's more of a repulsive type of attitude or aesthetic problem now with consumers,” he said.

Nova Scotia
New asthma device earns grant
HALIFAX -- A groundbreaking new asthma diagnostic device, designed to replace spirometry, has earned $2 million in federal funding for Dalhousie University and private-sector Montreal researchers involved in the development of an “oscillation spirometer.” The device measures airway function over a period of time as patients breath normally. Researchers have formed a company called Thoracic Medical Systems to commercialize the tool, which will see its first clinical application later this year in Halifax hospitals and at Minnesota’s world famous Mayo Clinic.

Prince Edward Island
Mandate winter tires: MD
CHARLOTTETOWN -- Dr Charles Trainor spends a lot of time thinking about car tires. After all, as PEI’s chief coroner, he’s seen at least 75 fatal driving accidents in his 25-year career. Now, inspired by Quebec’s December 2007 legislation that mandates the use of winter tires between November 15 and April 15, he wants PEI to follow suit. “I firmly believe that all-season tires are three-season tires — spring, summer and fall,’’ Dr Trainor told The Guardian.

Lobsters pinch cancer funding
CHARLOTTETOWN -- The federal government’s January 21 research grant announcements included $4.3 million for two UPEI medical research projects. Canada Research Chair in Biomedical Optics Bill Whelan received $2 million to support his research into laser thermal therapy and optoacoustic imaging technology for cancer treatment. But that news paled in next to the larger, $2.3 million grant to study a different kind of health -- that of lobsters.

Newfoundland & Labrador
Buckingham appeals conviction
ST JOHN’S -- Dr Sean Buckingham, the St John’s physician sentenced in early January to seven years in prison for sexual assault and drug trafficking, filed an appeal January 29. His lawyers claim his right to a timely trial was violated (he was arrested in May 2005), certain character evidence and evidence obtained by wiretap shouldn’t have been introduced, and one juror supposedly had a connection to one of the police investigators. Crown prosecutors filed their own appeal the week before.

The North
Average Inuit lifespan shorter
OTTAWA -- The average life expectancy in Canada’s North dropped from 67.8 years in 1989 to 66.9 years in 2003, according to Statistics Canada. In the same period other Canadians’ average lifespans rose by two years to 80.4. The Northwest Territories has the highest life expectancy of all the Northern regions, at 70.2, but even that is almost three years fewer than it was in 1989. On January 17, three days after the data was released, federal Minister of Health Tony Clement announced the creation of a new office on Inuit health and $2 million in new funding for research on Inuit health and suicide prevention.

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Medical news in brief: The weird, the wonderful and the woebegone

There seems to be no limit to the bizarre discoveries, bogus snake-oil cures, drugs-and-money scandals and ethical conundrums in the ever-fascinating world of medical news. Here's a sampling of the latest (including a marijuana-dispensing vending machine, as you can see from our custom-designed image, right).

Columbus brought pox home
ATLANTA — The New World gave the Old World potatoes, chilis, tomatoes, tobacco and, new evidence strongly suggests, syphilis. New genetic research from deep in the jungles of Guyana, published January 15 in PLoS Neglected Tropical Diseases by a team of Canadian, American and British researchers, connects Old World syphilis to strains of the skin infection yaws in the New World, by way of a bacterium associated with both. As well, syphilis happens to have first been reported in Europe in 1495, just two years after the return of the Niña and the Pinta. Blame it on Columbus, the authors conclude.

Big Apple cracks down on junk
NEW YORK CITY — Calorie counts will be displayed on fast-food menus as New York City officials try to encourage customers to make more informed decisions about what they eat. The New York City Board of Health passed the regulations last month; they affect fast-food chains with 15 or more outlets in the city, which account for roughly 10% of New York’s eateries. Some chains already provide nutritional information on pamphlets, but the calorie counts must be listed directly on menus beginning March 31.

Scientists spark vivid memory
TORONTO — Canadian scientists have accidentally stumbled upon an incredible discovery about the way memory works. While experimenting with electrical deep-brain stimulation for appetite suppression, an obese 50-year-old patient suddenly recounted a day he spent in the park with his friends 30 years ago in vivid detail. “It was a eureka moment,” lead scientist Dr Andreas Lozano, whose account was published January 30 in Annals of Neurology, told CP. “I think that in scientific discoveries these are the best ones. The ones you’re not expecting.”

Dope dispenser for patients
SAN FERNANDO, CA — The Timothy Leary Medical Dispensary in San Fernando, CA has begun using an unusual medical marijuana vending machine. After a patient’s authorization card and fingerprint are verified, and the bill settled, out pops the pot. Automation has cut the price of the drug to just $40 per eighth of an ounce; users are limited to one ounce a week. Two machines are now installed in California. Federal authorities are not amused and suggest that the vending machine operators could be prosecuted.

No scars with gene gel
BRISTOL, UK — A new kind of gene-suppressing gel speeds internal and external wound healing and reduces scarring. University of Bristol researchers developed the gel, described in the Journal of ExperimentalMedicine on January 7, after discovering that the gene osteopontin contributes to the production of collagen in scars. The gel also encourages the regeneration of damaged blood vessels and tissue in the skin as well as internal organs. “The next step will be to find a pharmaceutical drug which can do the same thing as this gel is doing,” one tissue expert told BBC News.

When killers want to heal
STOCKHOLM — Should convicted murderers be permitted to become physicians? Sweden’s Karolinska Institute thinks not. The school recently expel-led Karl Helge Hampus Svensson, 31, a first-year med student who served six and a half years for killing a union member in a neo-Nazi-inspired hate crime in 1999. Some have argued that Mr Svensson lacks the compassion necessary to become a physician; others say he deserves a second chance.

Have kidney, will travel
OTTAWA — There must have been some red faces at the CMA when they checked their ad on the National Post website recently. Adjacent to it was an article about Indian surgeon Amit Kumar, dubbed “Dr Horror” by the Indian press. Dr Kumar ran a surgery out of the basement of his home in a New Delhi suburb that sold kidneys extracted at gunpoint from India labourers to wealthy foreigners. Dr Kumar has relatives in Canada, visits regularly and is now suspected of hiding out here. That unfortunately placed CMA ad? It read: “CANADA NEEDS MORE DOCTORS.”

There’s metal in my maki!
NEW YORK CITY — Bluefin tuna from 20 sushi bars in New York City tested so high in mercury that a 70kg man should eat no more than six pieces every three weeks. Five of the restaurants had levels so high (over 1.4 parts per million) the FDA could take legal action. Canned tuna and fish sold in food stores contain much lower levels than that that sold as sushi, which comes from much larger fish who live longer and whose bodies accumulate more of the deadly metal.

Helpful plants under threat

SURREY, UK — Hundreds of medicinal plants are at risk of extinction, largely due to human activities that threaten the very species more than half of prescription drugs are derived from, researchers from Botanic Gardens Conservation International reported in a global study released last month. The endangered plants include magnolias, Hoodia and the Yew tree, from which the cancer drug paclitaxel is made. Overcollection and deforestation may also destroy potential cures “before they are ever found.”

Bone help may hurt heart
AUCKLAND — Calcium supplements may increase the risk of heart attack and stroke in healthy postmenopausal women, according to a University of Auckland study published January 15 in the British Medical Journal. Of the 1,471 healthy postmenopausal women with a mean age of 74, there were heart attacks among 36 women in the calcium group of 732 and 22 similar events in the 721 women receiving a placebo. Researchers caution that the risk of vascular event must be weighed against the benefits of increased bone density.

MD-penned torture flick hits screens
HOUSTON — US orthopedic surgeon Mark R Brinker has branched out from his trauma and reconstructive work — now he’s trying his hand at screenwriting. His first credit, Untraceable, an internet crime thriller starring Diane Lane, was just released in the US. It’s getting mixed reviews (the venerable New York Post calls it “a putrid little scab of a torture movie”) but he’s already at work on a horror flick called Fatal Frame.

Sepsis studies shock MDs

JENA, GERMANY — Contrary to what many believe and often employ, intensive insulin therapy and hydrocortisone don’t help, and may even harm, severe sepsis cases, according to the results of two clinical trials published in NEJM January 10, one from Germany and one from Israel. Hydrocortisone sped up septic shock reversal in some patients but didn’t affect four-week mortality rates, and intensive insulin therapy actually made patients worse off by causing hypoglycemia.

Girl switches blood types
SYDNEY — An Australian teenager on immunosuppressants since a liver transplant six years ago has become the world’s first person to switch blood types. An NEJM report published January 24 said Demi-Lee Brennan, 15, was type O negative before the transplant but the new liver’s blood stem cells invaded her bone marrow and changed her blood to type O positive. Doctors have called the case a “one-in-six-billion miracle” and now want to try to replicate the phenomenon.

Make the pill OTC: Lancet
LONDON — Oral contraceptives are so beneficial that they should be sold over-the-counter, urged the journal The Lancet in a January 26 editorial. The commentary accompanied a new systematic review published in the same issue that proved oral contraceptive use reduces lifetime ovarian cancer risk by up to 29%, preventing 100,000 deaths. “Very little is said in the press about the health benefits,” wrote the editorialist. “A strong message about the overall cancer preventing benefits of oral contraceptives would be a positive public-health message.”

Ezetimibe’s benefits in question
ROCKVILLE, MD — Simvastatin works just as well as the cholesterol combination therapy of ezetimibe plus simvastatin — and even better on some measures — according to surprising new data released in January by Merck/Schering-Plough. Cleveland Clinic cardiologist Steven Nissen called the results “stunning.” In response to the uproar, the US Food and Drug Administration announced it will conduct a review of the combo therapy. The American Heart Association, however, insists the data are too limited to draw a conclusion from.

Jehovah’s Witness saga continues
VANCOUVER -- The lawsuit brought by the Jehovah’s Witness parents of the sextuplets seized and given blood transfusions by the government last year, has stirred up the passions of a number of physicians. American neonatologist Robin Ohls testified January 21 that the transfusions weren’t necessary and the parents should have been given the opportunity to appeal the government’s seizure order. Dr Alfonso Solimano, who cared for the infants -- two of whom died -- dissented, saying of the transfusions, “It seemed the least potentially dangerous problem.” Final arguments are to be heard this month.

Seven compete for CMA presidency
REGINA -- A record number of physicians have entered the race to be the Saskatchewan Medical Association’s official candidate in this August’s election for Canadian Medical Association president in Montreal. Saskatchewan doctors have until February 26 to vote for one of the seven candidates, who include four FPs, one GP-anesthetist, one anesthetist and one otolaryngologist.

Image: NRM

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High heels boost sexual pleasure? I'll pass on the Manolos

Teetering about in two-inch heels gives the pelvic muscles a workout, and ergo increases a woman's sexual pleasure. That’s the claim made by stiletto-loving Italian urologist Maria Cerruto in European Urology, reports the BBC.

Dr Cerruto studied 66 women under 50 who wore two-inch heels. She found that their pelvic muscles had less electrical activity than their flat shoe-wearing sisters. This suggests that the muscles were at an optimum 15 degree angle to the ground, which improves the muscles' strength and ability to contract. And since these muscles assist in sexual performance and satisfaction, women can boost their sex life while clicking their heels, Dr Cerruto suggests.

I like high heels as much as the next gal, but I've got to ask: Dr Cerruto, wouldn't regular Kegel exercises do the same thing - minus the sore feet? I hate to rain on the MD’s Manolos, but perhaps her patients ought to look at this Washington Post diagram before filling their sling-back prescription. Heels can be blamed for everything from bad posture to bunions, among a dozen other conditions.

As for heels improving one's sex life, well any drag queen could’ve told you that.

Photo: Canada.com

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Grand Rounds: The Health 2.0 Explosion

This week's edition of Grand Rounds, a round-up of the best in the medical blogs, is online today.

This blog's coverage of Sermo and other doctors-only social networking websites appears first in the list of last week's top blog entries.

Canadian Medicine blogs about the rising popularity of doctors-only social networking websites, and that they’re in the process of expanding by opening up their registration policies in 2008 to include Canadians physicians.
There were a number of other very interesting blog posts, including an introduction to medical-education podcasts from Clinical Cases and Images; an essay on the value of social networking sites designed for "microcommunities" from Diabetes Daily; and another look at the hunt for Dr Amit Kumar, the Indian kidney transplant criminal who may very well be on the lam in Canada at the moment ("Punishment if a doctor is found guilty of illegal transplants in India? Two years jail time."), from Healthline Connects.

Thanks to Amy Tenderich at DiabetesMine.com for hosting.

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Monday, February 4, 2008

Manhunt for India's "Dr Horror" homes in on Brampton, ON

The anonymous detached house in anonymous Brampton, ON, seems like the perfect place for an internationally wanted felon to hide out. Unfortunately for Amit Kumar, aka Dr Horror, the notorious Indian doctor wanted for stealing kidneys from the poor to sell to the rich, the suburban town half a world away from his troubles just wasn't far enough.

Indian police and the RCMP believe when Dr Kumar fled India he headed for Brampton, where his family is thought to own the house shown in this Al Jazeera report:



Dr Kumar is accused of operating a dodgy basement clinic in Gurgaon, outside Delhi, where he allegedly duped 500 to 600 poor labourers into selling their kidneys for a pittance of around 75,000 rupees ($2,000CDN). Dr Kumar would then sell the organs on to rich foreigners or NRIs (non-resident Indians) for around 2 million rupees ($50,000CDN).

Muhammad Salim, one of the men who had a kidney taken, described his ordeal to NDTV television (quoted in the Times of London):

“I was approached by a stranger for a job. When I accepted, I was taken to a room with gunmen. They tested my blood, gave me an injection and I lost consciousness. When I woke up I had pain in my lower abdomen and I was told that my kidney had been removed.”
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Doc's peer-review breach appalls medical world

The men and women who give their time to review the research destined for medical journals pride themselves on a code of conduct stricter than that of the Knights of the Round Table.

Dr Steven Haffner (left) shattered that code when he leaked Dr Steve Nissen's incendiary rosiglizatone study to the drug's manufacturer GlaxoSmithKline 17 days before it appeared in NEJM last May, Nature reports (subscription required).

Dr Nissen's study rocked the medical world by raising serious cardiac safety concerns about the popular diabetes drug. Dr Haffner was one of the peer reviewers asked by the editors of NEJM to assess the study's 'rigour.' He sent it to a former colleague at GSK with whom he'd worked on an earlier rosiglitazone study.

"Why I sent it is a mystery," Dr Haffner, of the University of Texas Health Science Center at San Antonio, told Nature. "I don't really understand it. I wasn't feeling well. It was bad judgment."

There's as yet no evidence that GSK took any action after receiving the leaked study, and NEJM hasn't said whether it will take any action against Dr Haffner. But, by the sounds of things, he's going to be in deep trouble at work. "We are embarking on a complete investigation of the facts," Dr Haffner's boss, dean of medicine Dr William Henrich, dean of the school of medicine, said in a statement. "Once the facts are understood, we will take swift and appropriate action."

NRM spoke to Dr Nissen about his study in June.

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Murdered wife a drunk, accused doc's son says

The trial of Dr Joseph Roncaioli (right) gets more sordid by the day. The 72-year-old Thornhill, ON, gynecologist is accused of killing his wife after she allegedly gambled away the $5 million lottery jackpot she had won as well as her husband's savings.


The latest articles, including the Toronto Sun's "Mom boozer, son testifies" -- a personal favourite -- paint a strange picture of a woman who was a "mean and chronic drunk," according to her loving son, yet found to have a perfectly healthy liver by the autopsy.

But the most bizarre twist came when Dr Roncaioli himself took the stand last Thursday at the Newmarket courthouse. The well-respected doc who had injected his wife with a local anesthetic to treat a mysterious ailment, confessed to taking his sweet time calling 911 when he found her dead shortly after. "I thought 'my God, here I am treating my wife ... and she's dead, there goes my license,'" he said, according to the Toronto Star report.

The trial continues...

Photo: CTV Toronto

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