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Should we screen women over 70 for breast cancer? (Just don't mention "rationing")

Two new studies indicate that screening women over 70 for breast cancer is beneficial, despite the fact that it is not currently recommended, NRM's Christina Schallenberg . Regular screening, of course, would likely cost the public healthcare system a fair amount of money if it were implemented in Canada.

We wanted to know what doctors thought about this dilemma: to screen or not to screen? So we asked our readers what they thought of the new research: "Would it be a waste of resources to screen women over 70 for breast cancer?"

A whopping 85% responded, "No. Anything that can save more lives is worth a shot."

Just 15% answered, "Yes. It would be nice to screen everyone, but resources are too limited."

In a country where the phrase "healthcare rationing" has the same effect on Canadians as the utterance of "Yahweh" does on Orthodox Jews, perhaps the lopsided result shouldn't come as a surprise.

For instance, one reader commented:

This should not be a question of resources, rather a question of how much quality life can be added to a person by early diagnosis and treatment. The need for individual assessment increases with age.
Another reader, however, took umbrage with our question:
"saving lives is a bit of an inappropriate statement - we will all die. screening women for breast cancer will decrease the number that die of the disease, and hopefully keep their lives healthier and happier. I don't believe that it is a waste of resources - many in their 70s are very productive and have lots of years left. On the flip side, there are not as many alive by age 70 as in younger years, thus what type of numbers are we really looking at?"
What do you think? Does it make sense for provincial insurance plans to pay for breast cancer screening for women over 70?

Given that many provincial governments are stepping up their rhetoric about healthcare costs increasingly spiraling out of control, this kind of question may soon become commonplace across Canada, despite the public's deep-seated aversion to considering such things.

(Another recent example of this debate is playing itself out now in Quebec, where the two opposition parties are demanding the government offer funding to cover expensive in-vitro fertilization treatment.)


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THE INTERVIEW: Dr Mehmet Oz

(Note: this is a fuller web version of our interview with Dr Oz. A shorter version appears in the June print edition of .)

The wonderful land of Dr Oz

Dr Mehmet Oz (right) shot to fame when picked him to be her TV show’s health go-to guy. The mild-mannered, easy-on-the-eyes thoracic surgeon instantly captured the palpitating hearts of millions of viewers. He’s since parlayed his fame into a crusade to improve the healthcare lot of his fellow Americans. Dr Oz spoke to about those scrubs, the US election, and why the Canadian health system could never work south of the border.

The US Democratic leadership race is finally over. I know you’re a Republican, but did you have a favourite between and ?
Senator Clinton is from New York where I practise. She’s a very very smart woman. Her healthcare plan was probably the best. I have confidence that Senator Obama would also make a superb president. I suspect that Senator Clinton would be more effective, not because she’s a better person, but because she has more experience.

Do you agree with Senator Clinton that Americans need mandatory health coverage?
Yes. I think we have to have everyone forced to be part of the health plan, whether we give it to them for free because they can’t pay for it, or we subsidize it or make them pay for it together with their employer. We have to have affordable care for all.

What do you think of the healthcare system we have here in Canada?
Well, there’s good and bad. The good news is I think it works for Canada, because Canadians are very different from Americans. Canadians I think are much more willing to queue up and wait in line, they’re also much more polite about that process. America is about life, liberty and the pursuit of happiness, so people don’t like to wait. They don’t like having limitations, they want everything. So the Canadian system would feel very restrictive to Americans, but it seems to be quite popular among the Canadians especially the universal coverage element. The part that’s not popular with my Canadian friends and physicians is that because of the way the budgets are designed you end with limitations of services at the end of the year. And physicians I think don’t thrive in that environment. They want to be able to do what they have to do at any time. I think financial issues limit the ability of the healer to do his job.

Oprah’s a staunch Obama supporter, you’re a staunch Republican. Do you two ever argue about politics?
We don’t talk politics but I suspect we’d be very close to each other. I’m a Teddy Roosevelt Republican. I have a very firm belief in individual rights. I don’t like the government telling me what to do and I believe that people should have free will to pursue their dreams. I’m not socially conservative. I don’t believe that we should be intruding into the private lives of homosexuals and we should not be creating obstacles during the difficult time that women have when trying to terminate a pregnancy. I believe we should make it as easy as possible for women to carry a child to term and give it up for adoption. Today’s climate makes it difficult for women to do what’s best for them and their fetus.

’s the man for your Repulicans, but who did you like for leader?
There were a couple of good candidates. has proven himself as a capable leader. He’s got some great ideas.

Ever thought about going into politics yourself?
Not now. I’m spending a lot of time working with Oprah, trying to help educate Americans and Canadians about health. I think I have a lot of work to do to help us in the Western World realize that the only true salvation to our health care system is for us as individuals to take charge of our well-being. Once I’m done that, we’ll see. I think politics might be the next option.

How did you land the Oprah gig?
I had done the show several times and I always enjoyed it. Then I was asked to do whole separate show on CSI, on how we discover bodies and murders. It was well-received and Oprah has asked me back, because she believes that America can learn a lot about their bodies and she’s the perfect person to teach it to them. She’s very authentic leader. I kid her that she’s my teacher -- she’s a very good teacher.

Is she your patient?
I do help her take care of herself, but I do it more as a friend than as a doctor. She’ll call me periodically and ask advice, but I don’t see her in my office all the time.

Have you been a teensy bit afraid of Oprah since she tore into on her show?
No. I felt very badly for him -- I think he’s done something that he didn’t want to do and he was too weak to stop it. I’ve made many mistakes myself. When I write things and the data changes then I should be the first one to say ‘Hey, what I’ve written is incorrect.’

If Oprah asked you to have a makeover on the show, would you do it?
Oh yeah, sure. To get better fitting scrubs, or a better haircut.

The scrubs are very popular...
Yes, they like the scrubs.

Do you and ever compete for Oprah’s attention?
No. She’s a very good person, she always gives you her full attention when you’re with her. She’s very caring. She makes sure that the people in her life know that she loves them, and she takes good care of them.

She took you to Africa to see . How was that?
It was spectacular. I really understood her when we were in Africa, because I saw how passionate she is about teaching those girls. She said she now realized why she never had her own children, because it gave her the ability to have all these children instead. So I thought that was very elegant.

You also travelled to New Orleans and worked with the medical teams in the aftermath of Hurricane Katrina. What was that like?
It was life-changing. I had never actually been in a situation like that in this country, with people looking at death without dignity. We’ve always taken it for granted that we’re going to die, but what people want in death is dignity. They want to know that they won’t be lonely, they’ll be in a comforted area in their community with people that love them. And that broke down with Katrina. It was really a tragedy from that perspective. The natural disaster was compounded by the human disaster.

You contributed to former US senator and fellow physician ’s campaign. He was roundly criticized for diagnosing after watching some video footage of her.
The Terri Schiavo incident was a very embarrassing one for this country. Most people feel that families should have the right to make a decision about the death of a loved one without everyone looking in -- and without Congress creating a new session in order to legislate what should be done. We violated their privacy and I think we missed an opportunity to educate Americans about end of life issues. We should not be trying to guess at someone’s diagnosis, because it’s none of our business. The husband was probably right in that case, and he had his legal right to do what’s best for the woman he loved and loved him without people interfering from the outside.

You use scare tactics a lot in your books and on TV. Is that the only way to get people to shape up?
I don’t think the gentlemanly approach always works. You have to shake some people up. The reason for that is that our biggest enemy in educating people about their bodies in Canada and in America, is that they think they already know the answers. And they don’t. But they ignore the advice you’re trying to give. So I use the shock tactics as a wake-up call. I say “I know you think you have all the answers, but just look at this, I want you to see you the way I would see it” and most of the time, people say “My goodness, I never knew.”

Why should a doctor recommend the over the ?
The diet we have in our book is the actual medical diet, we didn’t make this up. We basically say eat the food that we have shown in medical practice to be good for you -- fruits, vegetables, grains -- based on the medical knowledge we have. So it’s been rewarding to me to learn not only how many patients have done it, but to hear so many nurses and doctors saying this is exactly what we do. This means I haven’t gone off too far on a ledge. What we try to do with the books is to make the diet understandable and accessible.

You prescribe yoga and massages to your patients. Do your colleagues think it’s flaky?
Some of them think it’s flaky. But I do these things myself. They work for me. When I’m tired at the end of the week, I get a massage. When I’m exhausted in the mornings, I do yoga. I know it works for me, so why wouldn’t work for my patients? Why should I treat them any differently than I treat me?

I understand you play mystical Islamic Sufi music for patients during operations. Are you inspired by Sufism?
Influenced by it. The biggest influence for my alternative medicine interest are my wife and her family. They are very insightful people. My father-in-law is a very well-known heart surgeon, Gerald Lemole. I saw how they were using it in their own family and to create a healthy environment, and I liked it. In Islam, of course, it makes you realize that you have to have your own connection with the divine, there should be no one between you and God, so it makes you very autonomous, very free thinking. Organized religion are the rules, Sufism and other mystic sects of Christianity and Judaism allow us to transgress those rules and actually begin to enjoy the game.

In a TV doctor dual, who’d win, you or Sanjay Gupta?
He’s a good friend of mine. I like him a lot. He’s come on my show a bunch of times and I’ve been on his show. He’s a very, very good doctor, he does a superb job at CNN.

5 things you didn’t know about... Mehmet Oz
How one of People’s Sexiest Men Alive handles the hordes of women hitting on him I’m always flattered when it happens, but I don’t send out those vibes
The weirdest alternative medicine he’s ever tried Energy medicine, like therapeutic touch and reiki. This is very foreign to me, because as a doctor, I’m used to seeing the data. I’m still sceptical even though my wife is a reiki master
Turkish delight or doughnuts? Baklava
Fries or salad (if fries were good for you)? Salad. The french fries taste good to me, they taste good to most people, but in the back of my mind, when I’m having a french fry, I think ‘in half an hour, I’m not going to feel good.’
On Oprah’s heart She has a beautiful heart. It’s pristine. It has no blockages and functions very elegantly.

Interview conducted by Judah Issa

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'MD-friendly' immigration bill passes

in a 120-90 vote in Parliament last night. The Liberals, who oppose the bill, chose to stay away to avoid defeating the bill and bringing down the minority government.

in our May issue. The bill aims to fast-track applications from certain skilled workers, including doctors. Critics say it will make it harder for less skilled workers to ever get into the country, even if they have family here.

NRM's Sam Solomon spoke to Dr Joshua Thambiraj, president of the Association of International Physicians and Surgeons of Ontario about the bill last month. Dr Thambiraj warned, "If we bring in more doctors, we will need to look at licensing." Most of the delays in getting IMGs working in Canada are acknowledged to lie with the medical Colleges that issue the licences, not immigration.

that the province will introduce legislation this summer to get foreign-trained doctors working faster, partly through provisional licences that will allow them to practise under supervision while they re-train.

"Whatever we do, we have to be assured that we do it in a way that maintains the standard that doesn't put the public at risk," Ontario College registrar Dr Rocco Gerace

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In the print edition: NRM's June issue

The print edition of June's National Review of Medicine will be landing on physicians' desks in the next day or two.

Here's a handful of highlights to look out for:

Our front page interview with Dr Mehmet Oz (right), thoracic surgeon, co-author of and health go-to guy on the . Dr Oz shares his thoughts on the US presidential candidates, Canada's wait-happy healthcare system and Oprah's "pristine" heart.

Liberal MP and family doctor 's searing indictment of the Harper government's handling of the BC safe injection site ruling. Prime Minister Harper's health and justice ministers vow they'll appeal Justice Ian Pitfield's decision that the feds have no authority to shut the Insite clinic down. (A indicates that 55% of Canadians think it's "a good thing" to provide IV drug users with a safe place to shoot up.) Check out Dr Martin's editorial on page 12.

The common practice of prescribing beta-blockers to at-risk surgery patients to prevent perioperative heart attacks could be killing more patients than it saves, according to a new Canadian study from the May 31 . See our coverage and interview with study author P J Devereaux on page 3.

Gone are the days kindly physicians would do non-billables like write like sick notes, phone in prescriptions and fill out insurance forms totally for free. And good riddance too. In a followup to we look at how to charge block fees without running foul of the College. See the full article on page 8.

Our Health Lawyer Lonny Rosen advises a doc with a drinking problem on how best to fess up to the College, page 17.

Can the osteoporosis drug zoledronic acid help women stave off breast cancer recurrence? Yes, says a new study presented at the recent meeting of the American Society of Clinical Oncology. See our story on page 18.

Full contents will also be archived on our website later this month.

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