Residents of Quebec have unwittingly become the subjects of a recent medical-research experiment conducted by a team of international researchers. If your thoughts suddenly turned to the CIA/MKULTRA experiments with LSD and brainwashing at McGill, don't worry: this year's experiment is nothing so nefarious.
In a new study, published online September 2 in the British Medical Journal, a team of Harvard and University of Alberta researchers studying direct-to-consumer advertising (DTC) realized that Quebec is the ideal place to compare the effects of DTC advertising on drug sales.
Why Quebec? The English-French divide -- Hugh MacLennan's two solitudes -- represents a unique situation. The entire population of Quebec lives in very close proximity to the United States, where DTC drug advertising is legal, but a portion of the population (the anglophones) are much more likely to see those ads than the other portion (the francophones) who would tend to stick to French-language and therefore Canadian television channels, radio stations and magazines produced in Canada, where DTC ads are illegal.
Harvard Medical School's Michael Law, the lead author, explained in a release:“It’s not an absolutely perfect control group... There’s obviously a small percentage of Quebec residents who are exposed to English language media. But as control groups go for this sort of observational study, it’s about as good as you get."
The researchers chose three drugs to look at: etanercept, mometasone and tegaserod. They compared sales among anglophone Quebecers to sales among francophone Quebecers, both before DTC ads began and after they started.
The results are rather surprising: the only significant difference between the two populations' sales were for tegaserod, but even that drug's sales eventually leveled out.
The conclusion to draw from this research -- though it contradicts what seemed before like common wisdom -- is that DTC advertising doesn't really work very well.
DTC IN CANADA?
The BMJ study comes at a time when DTC advertising is a hot topic in Canada.
Canadian research has shown that introducing DTC advertising increases government health spending on pharmaceuticals; one such analysis, which did an admirable job comparing the notoriously difficult-to-compare American and Canadian situations, was published last year by a respected University of British Columbia epidemiologist, Steven Morgan, in the journal Open Medicine.
CanWest, the owner of dozens of newspapers and televison channels across the country, filed a lawsuit in 2005 challenging the Canadian government's ban on DTC advertising. Their lawsuit, which is being dealt with in Ontario Superior Court, has not reached trial yet.
A separate CanWest lawsuit, filed in federal court against the Minister of Health and the Attorney General, claimed that the Canadian government was obliged to enforce its ban on DTC advertising even in American magazines that could be purchased in Canada. That suit was dismissed in July 2007. CanWest appealed, but in a decision this past June the Federal Court of Appeals refused to reverse the lower court's decision. (CanWest has not yet commented on whether they will attempted to appeal that decision further; check back here for Canadian Medicine follow-up in the next few days with CanWest's response.)
The Canadian Health Coalition, which is staunchly opposed to the introduction of DTC advertising in Canada, has put together a good-sized -- albeit selective -- collection of articles and resources on the topic on their website, including the text of affidavits filed in the CanWest challenge in Ontario.
Photo: Shutterstock
Suffering from administrative distress? (Jul. 7)
Fight back against paperwork-induced burnout
Recent severe cases of H1N1 flu worry officials (Jun. 29)
New emergence of severe infections remains unexplained
David Caplan aims for better, cheaper healthcare (Jun. 29)
A Q&A with Ontario's health minister
Tuesday, September 30, 2008
Unique Quebecers serve as research population for DTC pharma ad study
What's in the news: September 30 -- Tony Clement, MD politicians, Sarah Palin sympathy, and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 30.
Winnipeg's Health Sciences Centre hospital, where a homeless man died of a bladder infection last week after waiting in the emergency room for 34 hours, has implemented changes to prevent another, similar tragedy. [Canadian Press] Although it's not entirely clear yet why the man was not given the care he needed, the hospital plans to add staff and has come up with a colored wristband plan to keep track of patients who have yet to be triaged. [CBC News]
A short Globe and Mail profile paints a picture of Tony Clement's reelection campaign -- he won a seat in Parliament in 2006 by just 28 votes -- as being nearly a lock this time around. [Globe and Mail]
The Canadian Medical Association counts 12 physicians running in this year's federal election: seven for the Liberals, three for the Greens, and one each for the Tories and NDP. [CMA News] Profiles and links to the websites of each are available on the CMA's election page. [CMA] At first glance, the four incumbents -- all Liberals -- seem safe in their ridings; the rest of the physicians all face difficult races.
Newfoundland nurses are refusing to do cleaning, stocking and clerical work to pressure the government in negotiations. [Canadian Press]
New accusations arise about the sudden resignation earlier this year of Alberta's top public health staff. Alberta NDP leader Brian Mason says the doctors' departure was due to a disagreement with the government over how to alert the public to a syphilis problem. [Canadian Press] Health Minister Ron Liepert already took some flak for his work on the syphilis awareness campaign in August, which we wrote about here.
Meanwhile, just yesterday, Mr Liepert announced changes to the chief public health officer's role. He also clarified the relationship between the Ministry of Health and the new Alberta Health Services board. [CTV News]
Several Ontario physicians are planning on opening a medical-tourism surgical clinic to cater to Americans and other foreigners. [Globe and Mail]
Ontario's auditor-general blames poor hand hygiene and infection-control practices for the recent outbreak of C difficile in the province's hospitals. [Globe and Mail] I can't help but wonder: Didn't we already know that?
Edmonton obesity specialist Dr Arya Sharma is anti-marathon. [Dr Sharma's Obesity Notes]
Dr Martina Scholtens, having watched Sarah Palin squirm as foreign leaders ogled her, writes about how she deals with inappropriate sexual comments from patients. [Mothers in Medicine]
Two York University researchers are editors of a new book published by Canadian Scholars' Press Inc, called Women's Health: Intersections of Policy, Research, and Practice. [CSPI]
Grand Rounds is available at Monash Med Student. Be warned: the author is a former tank commander, and the post is filled with rather explicit photos of war. [Monash Med Student]
Beware of the "sumo virus," or "scrumpox." [BBC News]
Monday, September 29, 2008
The doctor's lounge is going the way of the dinosaur
By Christina Schallenberg, Clinical Editor, Parkhurst Exchange
Exclusive to Canadian Medicine
The Canadian doctor's lounge is on the road to extinction.
These days, when hospitals go through renovations, the doctor's lounge is often one of the first things on the chopping block. "It's no longer a priority," laments Dr Louise Nasmith, co-chair of the Collaborative Action Committee on Intra-professionalism (CACI), which works to improve collaboration between physicians. A similar complaint comes from Dr Preston Smith, head and academic leader of the Maritime Network of Family Medicine at Dalhousie University: "The doctor's lounge is disappearing in a lot of places," he says, citing a number of reasons, including space considerations and hospital authorities' failure to appreciate the benefits of the lounge. "The main value of the doctor's lounge," says Dr Smith, "is the promotion of intra-professional collegiality."
As doctor's lounges vanish, physicians aren't the only ones who will suffer: aside from good old socializing, lounge conversations have been known to speed up many a case. "I certainly have witnessed it in my career that a patient was on a wait list for six months, and after a conversation in the doctor's lounge the specialist said, 'I'll do that tomorrow,'" recounts Dr Smith.
Then there's the aspect of continuing medical education that takes place and, finally, the efficiency of face-to-face communication that allows for shortcuts. But as doctor's lounges dwindle in numbers, this kind of collegiality is bound to take a beating.
COMMUNICATION CATALYST
There still is a lounge at the Moncton, New Brunswick, hospital where Dr Smith practises once a week, and he believes that patient care -- and possibly even cost effectiveness -- are the better for it. A chat in the lounge is a great opportunity to be your patients' advocate without having to deal with faxes, emails or secretaries. It streamlines communication and promotes social interaction.
Without the lounge, physicians are more prone to working in isolation, without knowing the faces, names or specialties of some of their colleagues -- even if they're treating the same patients. Such simple "deficiencies" are among the major factors hampering an informal information exchange between physicians, according to the University of Toronto-based authors of the Structuring communication relationships for interprofessional teamwork (SCRIPT) study, published last year in the Journal of Interprofessional Care. As a result, collaboration suffers.
Dr Nasmith's Collaborative Action Committee on Intra-professionalism, established in 2007, was formed to address intra-professional issues such as the communication between doctors. It may not be a coincidence that such a group was deemed necessary at a time when the doctor's lounge has all but disappeared. And even in places where the lounge still exists, its character has changed.
Twenty-five years ago, the doctor's lounge was frequented regularly by two-thirds of the physicians at his Moncton hospital, Dr Smith recalls. But it's a different story today: "They're skipping coffee, skipping lunch, working right through the day," he says. Thanks to an exploding workload, there simply isn't time to hang out and have a coffee break with your colleagues.
GENERATION GAP
Younger doctors, more so than older ones, seem to avoid the lounge, Dr Smith observes. They may be worried that if they show their faces, a colleague will seize the opportunity to put even more work on their plates. With doctor's lounges vanishing across the country, it's also possible they've never seen one from the inside during their training, so they may not know what they're missing.
Doctor's lounges are disappearing from hospitals, yes -- but, this being the always-plugged-in 21st century, virtual doctor's lounges are ascendant. Social-networking has taken off on the internet, and the medical community has taken note: Asklepios, a Canadian Medical Association website, and Sermo, a private American firm, among other sites, offer doctors the opportunity to communicate with one another online, without having to worry about patients listening in. The content of the websites is similar to what you find in a real doctor's lounge: clinical queries, jokes, complaints and even a little bit of flirting.
The internet, however, doesn't make a good doctor's lounge -- a real-world one -- redundant. Dr Smith counts off some of the features that he appreciates in Moncton: a central location and comfortable seats, access to electronic health records to facilitate discussions about specific cases and -- last but not least -- good coffee.
So would he protest if his lounge were to close? "Definitely. And I wouldn't be alone."
Photo: Shutterstock
What's in the news: September 29 -- Dr Garlic, Réjean Thomas, and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 29.
A Victoria, BC, lawyer is attempting a defence of a man arrested for heroin possession based on the claim that because the government failed to provide a safe-injection site for him to use, his right to life and security of the person under the Charter of Rights and Freedoms were violated. The man has pleaded not guilty. [Victoria Times-Colonist]
Widely reviled South African Health Minister Manto Tshabalala-Msimang, a former obstetrician-gynecologist and public health expert who promoted natural products to fight AIDS -- like garlic, lemon and beetroot -- instead of antiretroviral drugs, has been removed from the health portfolio, causing AIDS activists the world over to rejoice. [Associated Press] The move is a result of the recent political upheaval in South Africa that has seen President Thabo Mbeki, who denied that HIV caused AIDS, leave office. Dr Tshabalala-Msimang famously banned Stephen Lewis, the former UN Special Envoy on AIDS in Africa and Canadian ambassador to the UN, from the country after he delivered a scathing speech about her policies in Toronto at the 2006 International AIDS Conference.
Vancouver police explained why it was necessary to use a Taser to subdue and arrest a 16-year-old mother who was holding her baby in her arms at the time of the shock. Social workers said that the baby, who was ill, might be smothered. [CBC News]
The UK will follow Canada's example by putting disturbing photos on cigarette packages to discourage smokers. [Medical News Today]
The Goudge Commission's report will be released on Wednesday at noon, and The Globe and Mail's Kirk Makin has the inside word on what measures the inquiry, set up to investigate the entire field of pediatric forensic pathology in Ontario in response to the numerous wrongful convictions made using the flawed testimonies of Dr Charles Smith, is likely to recommend. [Globe and Mail]
Ron Liepert, Alberta's health minister, faces criticism for not disclosing the preliminary report by a consulting firm hired to study the province's healthcare system. [Calgary Herald]
In other Alberta news: Mr Liepert has expressed his displeasure with the Calgary Catholic School District's decision not to offer the HPV vaccine to students. [Calgary Herald]
Dr Réjean Thomas, a Montreal doctor famous in Quebec for his work with HIV/AIDS patients, is the subject of a new biography/as-told-to autobiography by journalist Luc Boulanger, titled Réjean Thomas, médecin de couer, homme d'action. The book's preface is written by Dr Thomas's friend, ex-Parti Québécois leader André Boisclair. [Le Devoir] [Le Journal de Montréal] [Radio-Canada discussion] [buy it here]
Wayne Christian, the co-chair of the Shuswap Nation Tribal Council, in BC, wrote a very eloquent article in last week's edition of The Lancet about the medical, psychological and social consequences of Canada's residential schools system. He acknowledges the government's recent apology, but sharply criticizes Canada's decision to vote against the UN Declaration on the Rights of Indigenous People in 2006. [The Lancet (subscription required)]
Minnesota legislators are headed to Ontario and Manitoba to study the Canadian healthcare system. [Bemidji Pioneer]
Friday, September 26, 2008
What's in the news: September 26 -- Public reporting, Canadian drugs in Boston and Rwanda, and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 26.
Ontario will finally follow Quebec's lead by today starting to publicly report its hospitals' Clostridium difficile infection rates. The data will be available after 1:00pm today at www.health.gov.on.ca/patient_safety. By April 2009, seven other items will be included in the public reporting: MRSA, VRE, Hospital Standardized Mortality Ratio, central line infections, ventilator-associated pneumonia, postsurgical infection prevention, and hand hygiene compliance. [Canadian Press]
A program run by the City of Boston to provide workers with Canadian prescription drugs has been terminated by the Winnipeg pharmacy that had been supplying the medicines because of an apparent lack of interest. One city council member, however, theorizes that the federal Food and Drug Administration pressured Boston to drop the program. [Boston Globe] Recent news about counterfeit drugs produced overseas (remember the tainted heparin from China?) could have contributed to the low enrollment in the Canadian drug program, suggests the Wall Street Journal's Health Blog.
André Picard bemoans (as we all have done at least once or twice before) the shortcomings of Canada's Access to Medicines Regime, the law designed to provide the framework for generic drug companies to produce HIV medications to be sent to Africa. On Wednesday, the first shipment of drugs went out after four years of endless red tape. Mr Picard says that one shipment, however, may be the last. "[T]his tragic reality should fill us with shame," he writes. [Globe and Mail]
Former Member of Parliament Belinda Stronach and former British Prime Minister Tony Blair coauthored an op/ed in yesterday's Globe and Mail calling for more funding worldwide to prevent the spread of malaria in Africa. [Globe and Mail]
Dr Michelle Greiver gives an excellent analysis of the current situation for physicians buying electronic medical records (EMR) software in Ontario. [Dr Greiver's EMR]
A law enacted in Nebraska in July making hospitals "safe havens" for parents to abandon children without legal fears has encountered an unintended consequence. The law failed to specify an upper limit on the age of the children that could be abandoned; other states typically only apply the safe-haven law to infants under 1. On Wednesday, a 34-year-old father left 9 of his 10 children at Creighton University Medical Centre -- the youngest was just 20 months, the oldest a 17-year-old. [Omaha World-Herald] And in the last two weeks, reports USA Today, three children aged 11 to 15 were left at other hospitals. "We really opened a can of worms," Arnie Stuthman, the state senator who wrote the law, told USA Today. "We have a mess."[USA Today] [Wall Street Journal Health Blog]
Thursday, September 25, 2008
What's in the news: September 25 -- Leaky pipes, a new BC med school, and envious MDs
A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 25.
A ventilation leak of potentially fatal glycol fumes at a Saint John, New Brunswick, hospital forced a partial evacuation yesterday. One OR is closed today, but otherwise the hospital is back up and running as normal. [Saint John Telegraph-Journal]
The recent threat of a NAFTA challenge to Canadian public-healthcare protection rules might be just what some Canadian politicians (read: Gordon Campbell, Jean Charest, and ohers) have been hoping for, Canadian Doctors for Medicare member Dr Randall F White surmises in a new essay. [Canadian Doctors for Medicare] Besides what seems like a patently unfair dig at the man behind the free-trade threat, Melvin Howard, for allegedly being bipolar (unless I am misunderstanding him), Dr White's essay is a very smart piece of writing on the subject.
A British Columbia government health official wants to see a second medical school in the province, perhaps at Simon Fraser University. [Vancouver Sun] There was some talk in Coquitlam about a satellite campus of UBC's medical school a while back, which I wrote about in my article "Does Canada need more med schools?"
With Canada's healthcare system apparently entering a period of flux, the Royal College of Physicians and Surgeons of Canada is concerned about protecting medical education. [RCPSC]
Advice on how health professionals can avoid having an envious workplace: hire well, cooperate, encourage cooperation, communicate, and pair up mentors and trainees. [The Globe and Mail - The Office blog]
Wednesday, September 24, 2008
Suicide watch: The internet's deadly influence
I recently became aware of a very disturbing fact about this blog.
Looking at Canadian Medicine's traffic numbers not long ago, I noticed that the tenth most popular article on the site in terms of the number of pageviews is my short October 12, 2007 entry "The best way to die," which was a summary of and reference to a very good piece in The New Scientist. It's nearly a year old now, and not something I would have guessed would be of particular interest to many readers seeing as it's largely a recommendation to read the New Scientist article, but there it was: #10 overall. That's odd, I thought to myself. So I clicked on another button to examine the search-engine keywords that people have been using to find that article.
The most common terms weren't surprising: variations on 'best way to die,' predictably, find my piece near the top of Google's search results. But as I began flipping through the search-engine terms that occurred less frequently -- just one or two or three times -- I discovered that some readers seemed not to be searching for a sort of tongue-in-cheek article like the New Scientist's that explores the science behind fatal accidents, but instead appeared to genuinely be looking for information on how to kill themselves.
Searches that readers used to turn up my article include:best way to die from carbon monoxide
This is a disturbing thing to learn, that my article may be serving as a resource in some manner or another for people who want to commit suicide.
"best way to die" "hanging"
best way to cut vein
best way to die cyanide?
best way to die heroin
best way to die poison monoxide in home
die from hanging whats the best hieght
drowning the best way to die?
exsanguination how long to die
fast way to die
is carbon monoxide a painful way to die
is cutting the arota the fastest way to die
the best way to die now
I'm not unaware of the medical literature on the influence of the internet on suicides. University of Bristol researcher Lucy Biddle and a team of colleagues published an excellent report in the British Medical Journal in April that, while acknowledging the potential of beneficial effects of internet use in preventing suicide by connecting patients with support communities and other helpful information, also showed that 19% of search engine hits for terms similar to mine (such as "how to kill yourself") pointed to pro-suicide sites.
Now, of course, I don't believe that means that my article was necessarily in bad taste -- there's nothing wrong per se with writing or reading about death -- but I can't help but worry that things I wrote about an "optimal way to go" could be used by readers who want to do themselves harm.
But at this point, there emerges a journalism ethics question: Is it incumbent upon a journalist to protect the public from information that could cause someone harm?
I think the answer is that there is no easy answer. I can think of cases where the answer is yes, and clearly so -- publishing the military's troop movements, for instance, or printing the home address of a public official or celebrity -- but what about opinion articles or editorial cartoons (as in the outrage over the Danish cartoons of Muhammad, which sparked riots), or cases like mine in which the information is based on science and was never private to begin with?
Rather than remove potentially harmful information -- Biddle et al sensibly write: "Any attempt to regulate suicide promotion needs to strike a balance between freedom of expression and public protection and the global nature of the internet" -- the report recommends:"It may be more fruitful for service providers to pursue website optimisation strategies to maximise the likelihood that suicidal people access helpful rather than potentially harmful sites in times of crisis."
What the report is referring to is efforts to influence search-engine rankings (a field called search-engine optimization, or SEO), but I think the concept can be applied just as well in my case.
The solution, then, it seems to me, is to append a short warning to the article to provide readers with the website addresses and telephone numbers of suicide hotlines (in Canada and in the US). Just in case.
Canadian MDs get their own social network
Canadian doctors now have access to the 21st-century equivalent of the doctors’ lounge with the release last month of a social and professional networking website created by the Canadian Medical Association (CMA).
Modelled in part after existing social networks like the incredibly popular Facebook and Sermo, a social network for American physicians, the new website, named Asklepios for the Greek god of medicine, will give doctors a private place to talk to one another about anything from clinical techniques to their golf swings (except protected information, of course, like identifiable information about patients).
“It helps connect physicians with their colleagues across the country, facilitates the sharing of best practices, and fosters a deeper sense of professional affiliation,” lauded CMA past-president Dr Brian Day in a news release.
After a small but successful four-month pilot test of the site, now available at www.asklepios.ca, the CMA envisions rapid growth in membership among doctors and medical students from across the country.
STATION TO STATION
The idea for Asklepios began last year when Jay Mercer (pictured above using the site), a technologically inclined Ottawa family doctor and the medical director of the web division of CMA subsidiary Practice Solutions, was thinking about a hobby of his: ham radios.
While on a ship to Alaska, struggling with his radio’s reception, Dr Mercer turned to www.eham.net, an online community of amateur radio enthusiasts. In short order, a fellow radio operator from Florida made a call on his behalf and wrote back with detailed, technical instructions in answer to Dr Mercer’s question. His radio humming along smoothly as the boat chugged ahead, Dr Mercer realized something profound: “Doctors are like ships passing in the night,” he thought to himself. The medical community is huge and the answer to almost any imaginable question is surely out there somewhere, but doctors have no way to access one another’s knowledge.
If Dr Mercer could get advice from complete strangers about something as esoteric as the intricacies of broadcasting at sea, why shouldn’t Canada’s doctors -- and, by extension, their patients -- benefit from the same kind of innovative technology? (After all, other recent social networks have targeted far more unlikely audiences: Totspot, for children; A-Space, for CIA and FBI agents; First Wives World, for divorcées, OpenBottles, for oenophiles; or Elftown, for sci-fi fans -- to name just a few.)
Back on dry land, Dr Mercer set about designing what would become Asklepios.
HOW IT WORKS
Asklepios is gated in order to permit only users with CMA member numbers to register. Privacy is crucial: in an open forum, where patients could read doctors’ comments, no one would feel comfortable posting their opinions. But in Asklepios, doctors have already discussed delicate matters amongst themselves, like the best way to give kids their immunization shots, how to use your iPhone in your practice, and advice on electronic medical records, for instance. (Dr Mercer has already changed one element of his clinical practice since Asklepios began operating: he read some interesting advice on Pap smear technique and learned to do the procedure better than he had done it before.)
Unlike Sermo, however, doctors’ comments will not be pseudonymous. “We wanted a highly professional, secure environment where doctors feel comfortable enough to use their names,” says Dr Mercer. “You can connect on a personal level.”
The matter of real names vs pseudonyms is the biggest difference between Asklepios and Sermo, because Dr Mercer is hoping Canadian doctors will choose Asklepios over Sermo which has plans to soon expand internationally. Sermo had initially hoped to enter the Canadian market before the end of the year, but that date has now been pushed back to “early 2009,” says a spokesperson. The CMA has also beaten the American company RelaxDoc.com, another potential competitor, to the punch. “We are planning to open the site to international physicians,” says Erin Mulgrew, the company’s communications director. “We’re just working on the back end of that” to make sure it’s possible to verify that users are really doctors. That process isn’t a problem at the moment in the United States -- “Right now we verify with the DEA [Drug Enforcment Administration],” says Ms Mulgrew -- but the CMA has a leg up on them in Canada: when a user attempts to register for Asklepios, the software checks the name against the CMA’s already-verified database of all Canadian physicians and residents, including doctors who are not CMA members. (Several other similar sites, including Tiromed and New Media Medicine, allow anyone to register.) RelaxDoc.com expects to be up and running in Canada by the end of the year, slightly ahead of Sermo.
Another salient difference between Asklepios and its commercial competitor, Sermo, is the revenue question. Sermo is privately owned and makes money by selling read-only access to the site to pharmaceutical companies, who are itching to hear doctors’ unfiltered opinions about their drugs. “[Asklepios] is a service for doctors,” says Dr Mercer. “It’s built as a private physician community, and there is no plan to monetize it. The CMA would not have any appetite for that type of thing.”
Uptake hasn’t picked up to full speed, in part because the marketing campaign to all CMA members hasn’t begun in earnest yet; the site’s launch last month was only to attendees of the annual meeting. As of September 23, the CMA reported that over 350 physicians had registered for Asklepios, but a spokesperson predicted many more soon to come after the site is marketed to the organization’s entire membership.
THE ASKLEPIOS EXPERIENCE
At the CMA’s annual meeting in Montreal last month, I sat down with Dr Mercer for a tour of the site. The platform ran smoothly and looked slick; the design was simple and clear. Especially for a site that had been only an idea about seven months prior, the product was very attractive and well thought-out. The most important part of the site, the forums in which doctors can write comments back and forth to one another, was very easy to read in textual and design terms. (A slew of new features slated to be released this month weren’t ready when Dr Mercer showed me the site, so I can’t comment on them. Planned additions include blogs, audio, photos and videos.)
It occurred to me that the CMA has done an admirable job of creating a social networking site -- some of which, like Facebook, can be overwhelming to people not well versed in the web -- that even the most technology-averse physicians could grasp without much of a struggle.
Photo: Sam Solomon
What's in the news: September 24 -- More shocking news on Tasers, dance medicine and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 24.
More details on the September 14 Tasering incident in Halifax: When paramedics ran into trouble getting a diabetic man with low blood sugar to calm down, police suggested an "alternative therapy" and shocked him, causing him to scream, bite off part of his tongue and lose the ability to walk for three days. A Taser company medical advisor says that might well have been the police officers' safest decision. [Canadian Press]
The man accused of stabbing a fellow bus passenger in the chest in Northern Ontario should not have been discharged from a Wawa, Ontario, hospital when he requested psychological help, his mother says. [Winnipeg Sun]
Dancers are at extremely high risk of suffering musculoskeletal injuries and pain, three "dance medicine" researchers from Toronto report in this month's issue of Archives of Physical Medicine and Rehabilitation. [Archives of Physical Medicine and Rehabilitation abstract]
Anxious people may be more likely to detect their diabetes early, according to a study published this month in Psychosomatic Medicine by a team of researchers from the University of Waterloo and from Halifax. [Psychosomatic Medicine abstract] [Reuters]
Certain types of honey are effective at treating sinusitis, reported researchers from the University of Ottawa yesterday at the American Academy of Otolaryngology-Head and Neck Surgery conference in Chicago. [Canwest News Service]
On Monday, McMaster University researchers presented a study showing that a shorter course of three weeks of radiation is just as good as a longer one of five for women who have gone through breast-cancer surgery. Follow-up twelve years later showed equivalent rates of recurrence, though the researchers pointed out that it may not be a good option for all patients. They discussed their research on Monday in Boston at the American Society for Therapeutic Radiology and Oncology's annual meeting. [McMaster]
Doctors see fewer patients near the end of their hospital shifts because of stress and fatigure, reports a Vancouver hospital. [Vancouver Sun]
A cruise ship mistakenly issued a warning to its passengers not to drink the water in Saint John, New Brunswick. [CBC News]
A new meta-analysis in the Journal of the American Medical Association shows that using an inhaler for 30+ days increases by 58% COPD patients' risk of suffering a heart attack or a stroke, and of dying as a result of one of those causes. Why? Well, the authors have some theories but at this point they're just that -- theories. No one knows. Nevertheless, there is a suggestion in the authors' comments that doctors may need to reconsider the risks and benefits of longterm inhaler therapy for COPD patients. [JAMA abstract] [Reuters] However, the drug companies behind Spiriva (tiotropium, the drug in many inhalers) say the study is wrong. Arriving in journalists' email late yesterday afternoon was a release from Boehringer Ingelheim and Pfizer filled with data compiled from the companies' research on tiotropium and cardiovascular death, contradicting the JAMA study, which the companies criticize for what they believe was its reliance on too few studies and its failure to distinguish between two different types of anticholinergics: their own tiotropium, and another one called ipratropium. [news release] Another study, published last week in Annals of Internal Medicine, seems to back up the drug companies' complaint: a team of US researchers (including several who receive grants from Pfizer and Boehringer Ingelheim) reported that ipratropium may raise the risk of death in COPD patients. [Annals of Internal Medicine abstract]
This week's anthology of the best entries from health bloggers, Grand Rounds, is available at KevinMD. [KevinMD]
Tuesday, September 23, 2008
What's in the news: September 23 -- Delirium, checklists and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 23.
Elderly patients on statins have a 28% higher risk of post-surgical delirium, according to a new study by a team of Toronto researchers published in this week's Canadian Medical Association Journal. [CMAJ] MedPage Today reported on the study yesterday, writing:[...] Dr. Redelmeier said that on the basis of their study, he and colleagues concluded that it was reasonable to stop statin therapy prior to elective surgery and to resume afterwards. "This costs nothing, and it may be beneficial," he said, "but reasonable physicians may disagree about this recommendation."
In fact, one reasonable physician has already disagreed with it. In the same issue of the CMAJ, Harvard Medical School physician Edward Marcantonio criticizes the study's conclusions based on what he believes to be methodological problems, calling the results "plausible" but insisting that the connection must still be confirmed. "What is the clinician to do right now?" he asks. "Unlike the authors, I believe it is premature to recommend stopping the use of statins in elderly surgical patients. The methodology used in this study is simply too limited to compel practice change." [CMAJ commentary]
Officials are looking into allegations that a man died after spending 34 hours in the emergency room in a Winnipeg hospital. [Canadian Press]
On the fifth anniversary of Insite, Dr Julio Montaner, the BC-based president of the International AIDS Society, called the Conservative government's anti-harm reduction policy "genocide." "These people, they have no morals. They want these people (addicts) gone," he said. [Vancouver Province] For someone who's been accused by the federal health minister of becoming an advocate rather than a scientist, Dr Montaner's words are particularly bold and unapologetic: what is clear is that he is supremely confident that the results of his extensive research on Insite are accurate and that they demonstrate the facility's immense value.
Just a week after Ontario doctors were offered a 12.25% raise over the next four years, Manitoba's doctors have signed a deal for a 16.5% raise over three years. [Canadian Press] As seems to be normal these days, the new deal was signed around six months after the last one expired. These delayed and endless negotiations are endemic across the country when it comes to physician remuneration. Everyone knows it's a complicated subject, but six months? That's outrageous -- especially when it happens again and again.
After much news of criticism yesterday of the opening of the private Copeman Healthcare Centre in Calgary, (the Canadian Press reported that one protester accused owner Don Copeman of stealing her family doctor) Western Standard magazine launched a broadside against "the advocates for maintaining the government monopoly on healthcare delivery in Alberta." [Western Standard]
More depressing financial news from south of the border: with the US economy in a tailspin, Americans are cutting back on health spending, seeing the doctor less (to avoid co-pays) and declining to fill prescriptions. [Kaiser Network]
Dr Peter Pronovost, the Johns Hopkins researcher who's been pushing the use of simple but surprisingly effective checklists in hospitals, is one of four physicians selected as recipients of this year's $500,000 MacArthur "Genius Awards." [Wall Street Journal Health Blog] Graham Lanktree wrote about Dr Pronovost's work in the National Review of Medicine, and the influence he's had in Canada, earlier this year. [NRM] An aside: another winner is the excellent classical music critic Alex Ross.
Lucy Maud Montgomery, the famed Canadian author of Anne of Green Gables, committed suicide, revealed her granddaughter in an article in the Globe and Mail. [Globe and Mail]
Lawsuits against bloggers are becoming increasingly common. [Poynter] I recently wrote about a lawsuit in Boston in which a physician's blog resulted in him being forced to settle a serious malpractice case. [Canadian Medicine]
And, the best from Canada's physician bloggers:
Dr Arya Sharma, using a new study as evidence, dissects the claim that obese patients shouldn't be eligible to have knee replacement surgery. [Dr Sharma's Obesity Blog]
In a dictated consultation letter: "... and would appreciate if you would blow the patient together with me." [Rheumination]
Monday, September 22, 2008
What's in the news: September 22 -- Rock talk, BC abuse, David Blaine and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 22.
All three Newfoundland gynecologic oncologists who had threatened to leave the province have agreed to stay after Premier Danny Williams finally offered them extra money to bring their recent raises in line with the rest of Newfoundland's oncologists. "We have to come up with the money in these circumstances, but when you're in the middle of a collective agreement, to step outside of that collective agreement and try and deal with a matter, it's a dangerous precedent," Mr Williams told CBC News. "But when you're talking in terms of patient health and safety, and well-being, and health care, then sometimes you just have to step up." [CBC News] [St John's Telegram]
A new private clinic operated by Don Copeman opens today in Calgary, sparking criticism from a pro-medicare group. [Calgary Herald] Read the National Review of Medicine's report on Mr Copeman's expansion plans from January this year. [NRM]
Complaints of girls' mistreatment at the hands of physicians in British Columbia detention system, include accusations of sexual abuse, have led (over a year later) to recommendations from the province's independent children's watchdog agency on policy changes to avoid future problems. [Canadian Press]
Medical researchers in British Columbia claim to have identified a new neurological disorder in which sufferers are chronically lost. [UBC]
The Alberta Medical Association is demanding a clear pandemic plan from the province's new Health Services Board. [Canadian Press]
Former New York City mayor Rudy Giuliani takes a few potshots at Vancouver's Insite. [CTV News]
Dr Yves Bolduc, Quebec's health minister, gets profiled by Quebec City journalist Julie Lemieux. One tidbit: like many successful doctors, he can get by on just a few hours of sleep a night. [Le Soleil, French only]
A Globe and Mail analysis of Justin Trudeau's workout. [Globe and Mail]
In an article on poverty and children's health in the journal Healthcare Quarterly, Children's Hospital of Eastern Ontario president/CEO Michel Bilodeau prescribes a series of treatments to reduce the burden of poverty on children's well-being. [Healthcare Quarterly]
The Canadian Medical Association takes credit for getting healthcare into the election spotlight. [CMA News]
The Canadian Institutes for Health Research is the target of a con: "Chelsea," who claims to be a CIHR employee, is offering to pay people to participate in a study, but she needs them to pay a refundable $50 fee to register. "Please be advised," writes CIHR in a notice to the public today, "that this is a SCAM, and not a legitimate research
study." [CIHR]
Is it almost time for a Liberal-NDP merger? [Toronto Star]
In the mostly overlooked Alberta Liberal leadership race, between the party's deputy leader, a doctor and a pharmacist, there hasn't been much to miss, reports Don Braid. [Calgary Herald]
Electronic, smokeless cigarettes don't help smokers quit, the WHO says. Also, these products have not been tested for toxicity or other potential safety problems. [Reuters]
John McCain probably regrets writing that deregulatory measures that succeeded in the US banking industry can do the same for the healthcare sector. Oops. [Wall Street Journal Health Blog]
David Blaine, the ostentatious American magician, risks going blind from his latest stunt, in which he plans to hang upside down in Central Park for 60 hours. [Medical News Today]
Friday, September 19, 2008
What's in the news: September 19 -- Election talk, a Newfoundland fight and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 19.
The Canadian Medical Association Journal has published the responses of all five major political parties to a list of 10 questions on healthcare. Read the CMAJ's overview here (PDF) and the responses to each question here (PDF).
The rift between the Newfoundland government and the province's medical association is larger than ever after Premier Danny Williams accused medical association president Rob Ritter of interfering unhelpfully in negotiations to keep disgruntled gynecological oncologists in the province. [Canadian Press]
New clinical practice guidelines released yesterday by the Canadian Diabetes Association urge doctors to identify and treat a condition known as "prediabetes," which can lead to full-blown diabetes. [Canadian Diabetes Association guidelines (PDF)]
Paracetamol (marketed as Tylenol) use in children might lead to asthma and several other conditions, report researchers in this week's asthma-themed issue of The Lancet. [The Lancet] [Globe and Mail]
Thursday, September 18, 2008
Canada's healthcare protectionism violates NAFTA, claims businessman
For the first time ever, the Canadian government is facing a legal threat over the question of whether restrictions on foreign private investment in the healthcare sector are in violation of the North American Free Trade Agreement (NAFTA), Embassy magazine's Luke Eric Peterson reports in a column published yesterday.
Mr Peterson writes:Successive governments—both Liberal and Conservative—have long insisted that Canadian trade negotiators succeeded in "grandfathering" medicare under the North American Free Trade Agreement. In other words, our health care system -— at least as it stood in 1994 when the NAFTA came into force —- is beyond the reach of foreign insurance companies and HMOs seeking to re-model it after the U.S. system.
A lawsuit is being threatened by Melvin J Howard, the CEO of the Arizona-based Centurion Health Corporation, who spent five years and millions of dollars trying to build a $154-million private surgery clinic in British Columbia -- it was envisioned to be the largest such clinic in the country -- but he claims he was chased off by British Columbia cities' "politically motivated" zoning rules and bylaws because his business is American.
What's less clear, however, is whether the ongoing flirtation by various provinces with greater private financing and delivery of certain forms of health care is slowly eroding Canada's legal defences.
At least one American citizen is keen to find out.
Mr Howard's case, as he lays it out on his company's blog (he first threatened to sue under NAFTA as early as March 19, 2008), is based on the following logic:
1. Recent reforms in various Canadian provincial healthcare systems (including the Supreme Court of Canada's 2005 ruling in Chaoulli v Quebec) have created new private investment opportunities for Canadian businesses.
2. NAFTA dictates that American, Canadian and Mexican businesses must have equal opportunities in all three countries.
3. Centurion wasn't able to take advantage of the same opportunities some private Canadian companies have -- because, says Mr Howard, his business is based in the US.
Ergo: NAFTA violation.
Or so claims Mr Howard. But Embassy's columnist, Mr Peterson, doesn't seem to be convinced yet. Though he writes that a healthcare-related NAFTA challenge has been a long time coming, he implies that this case isn't necessarily going to be the next softwood-lumber dust-up:As someone who specializes in writing about these types of cross-border lawsuits, I should caution that not every such threat leads to an actual arbitration under the NAFTA. Moreover, even when arbitrations are launched, that doesn't always mean that investors can convince a panel of arbitrators that they have suffered breaches of NAFTA protections owed to them.
At the end of August, Mr Howard and the Canadian government exchanged correspondence about setting up a consultation to discuss Mr Howard's claims. But with Prime Minister Stephen Harper clearly about to call an election at the end of August, Mr Howard said he would put a hold on talks until after the October 14 election is decided.
And at this stage there are more questions than answers about Mr. Howard's allegations.
"At that time," he wrote, "Centurion will proceed [and] if after the consultations there appears to be no resolution we will move to go to arbitration."
Update, September 19: The largest labour union in Canada, the Canadian Union of Public Employees, is taking this matter very seriously. "For everyone who thought health care was safe from NAFTA, this is a reality check," said national president Paul Moist in a release. "The threat also exposes the serious risks that follow from the privatization schemes British Columbia and other provinces have allowed to creep into their health care systems. NAFTA threatens to transform that modest flow, if it is not immediately abated, into a torrent," said says Stephen Shrybman, a trade laywer.
Photo: NAFTA Secretariat
What's in the news: September 18 -- Tasers, the Wii Senior Olympics and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 18.
Nova Scotian medical examiner Dr Matthew Bowes has concluded his investigation into the 2007 death of schizophrenic Dartmouth resident Howard Hyde while he was in custody about 30 hours after police shot him with a Taser. His findings? Mr Hyde died of a "excited delirium," and his death was unrelated to the Taser shock and therefore accidental and in no way the liability of the police. [Halifax Chronicle-Herald] But "excited delirium" is not a recognized medical condition; the American Civil Liberties Union has derided the use of the term as a way of "white-washing" the deaths of inmates, as this National Review of Medicine article reported last fall.
Coincidentally, yesterday, another Canadian died after being Tasered by police while in custody, in Toronto. By one count, 23 Canadians have now died after being Tasered. [Globe and Mail]
The government of New Brunswick has finally relented and agreed to review its policy limiting the number of doctor billing numbers that can be issued to certain geographical regions. The policy was intended to make sure enough doctors would be available to work in rural areas, but the medical community has long railed against the regulations. [CBC News]
Welcome to the Wii Senior Olympics! From September 27 to October 3, Toronto-area senior citizens will be competing for Nintendo supremacy in a grueling set of video game matches of virtual tennis, virtual golf, virtual bowling and the virtual triathlon of all three games. The competition is being held by Lifecare Operations, a long-term care company. [Lifecare Operations]
The Canadian Lung Association endorses the Conservative plan on cigarillos and tobacco, which would ban the sale of individual smokes and outlaw the use of kid-friendly flavourings like cotton candy and bubble gum. [Canadian Lung Association] [Canadian Press]
The federal minister of agriculture, Gerry Ritz, has apologized for making some rather unpleasant jokes about the Canadian listeriosis outbreak. [CBC News] Meanwhile, the Maple Leaf sanitizing plant in Toronto, which has been implicated in the spread of the bacteria, is set to reopen next week. [Toronto Star]
The College of Physicians and Surgeons of Ontario has removed a threat of disciplinary action from its draft policy warning doctors that they could face complaints from the Ontario Human Rights Commission if they refuse to perform any medical services because on religious or moral grounds. (Today the College will debate its draft policy in order to finalize it.) [National Post] Margaret Somerville, the founding director of the McGill Centre for Medicine, Ethics and Law, expresses her support for doctors' freedom of conscience, and reports that Alberta's physician licensing body is considering the matter now. [Calgary Herald]
An incentive program tested in four BC hospitals' emergency rooms was successful in reducing wait times. [Canadian Press]
Dr Keith Martin, a Liberal MP from British Columbia and a former physician, was exaggerating when he threatened to leave politics because of his frustration that getting anything done was so difficult. He's not going anywhere... so long as he keeps winning elections. [Vancouver 24 Hours]
Bisexuals' mental healthcare needs are not being met, reports a new study from Toronto's Centre for Addiction and Mental Health. [CAMH]
To prevent the onset of heart disease, Dr Yoni Freedhoff, an Ottawa family doctor and obesity specialist, ate a whole bag of President's Choice Two-Bite Brownies. [Weighty Matters]
Grey's Anatomy, the phenomenally popular hospital soap opera, partnered with the Kaiser Family Foundation to insert some information about HIV into the plot of their show. Kaiser researchers have now announced that viewers learned a surprisingly large amount about HIV from watching. [LA Times]
Do "doctor moms" suffer higher rates of pregnancy complications because of the physical demands of their work? The Boston Globe reports that Columbia University researchers are studying that question now, while other researchers look at the way expectant and new mothers are treated in the medical profession. [Boston Globe]
The latest edition of Health Wonk Review, a collection of the best recent blog entries on health policy, is online now. [Disease Management Care Blog]
On Friday, an interesting medical ethics conference comes to Edmonton: "Between a Rock and Hard Place: When Healthcare Providers Experience Moral Distress," the second iteration of the meeting held in Calgary in May. Hosted jointly by the College and Association of Registered Nurses of Alberta and Alberta's Provincial Health Ethics Network, the September 19 full-day conference will feature speakers from across Canada and the US. [more info]
Wednesday, September 17, 2008
What's in the news: September 17 -- Listeriosis blame, burns, budgies and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 17.
The proposed agreement between the Ontario government and the province's physicians is flawed, Ontario NDP health critic France Gélinas tells NorthernLife.ca. But she doesn't believe the deal is bad because it doesn't pay doctors enough -- quite the opposite, in fact. "[A]s with the last agreement in 2005, physicians’ salaries are going up and promises of better access to care and reduced wait times are being made," she said. "But paying physicians more in 2005 did not improve access to care or reduce waiting lists - so why should it now?" Ms Gélinas decries the government's failure to link funding with real changes, instead pouring more money into an increasingly out-of-date fee-for-service model rather than community health centres, health promotion, chronic disease management and more funding for other providers.[NorthernLife.ca] In other news on the tentative Ontario deal, Ontario Medical Association president Dr Ken Arnold is refusing all interviews this week, Canadian Medicine has been informed.
Canadian researchers have made a major advance in oncolytic virotherapy, a cutting-edge area of research that seeks to use viruses to kill cancer cells. Scientists from Montreal and Ottawa report in the journal Proceedings of the National Academy of Sciences that another type of molecule, called histone deacetylase inhibitors or HDIs, can prime the cancer cells to be targetted by a virus that is harmless to normal human cells but fatal to cancer cells. Experiments have so far been limited to laboratory work, but human trials could begin within a year or two, McGill's lead researcher says. [McGill University]
Journalists in Sault Ste Marie, Ontario, were expelled from a meeting about the future of the region's healthcare. [SooToday.com]
The Canadian Medical Association Journal editorial board blames the Conservative government for dismantling the food-inspection system and allowing self-monitoring. The editors call for a public inquiry into the matter. [CBC News]
Canada's healthcare system doesn't compare favourably to those of most Western European nations, reports the Frontier Centre. [Canadian Press] Given all the other, similar discouraging studies we've heard over the years, this should come as no surprise.
Don't miss this excellent Toronto Star feature on bonding among severe burn victims, and how burn care works. [Toronto Star]
An update on the case of the Moorish-American parents who were arrested in Toronto after bringing their allegedly malnourished infant to the hospital but refusing treatment: the mother has been released on bail and the father is being held until his hearing tomorrow. [Toronto Star]
The controversial retired hockey player Eric Lindros donated $5 million to the London Health Sciences Centre, which the Canadian Press reports is believed to be the largest one-time charitable donation ever by a Canadian athlete. [Canadian Press]
A Canadian weight-loss supplement company, Wellnx Life Services, is being sued by customers in sixteen US states. [press release]
Canada becomes the first country in the world to approve the new anticoagulant rivaroxaban to prevent venous thromboembolic events (VTE) after hip and knee replacement surgeries. The once-daily pill has proven to have significant benefits over the current treatment, enoxarapin, with similar rates of side effects like bleeding. [Bayer press release] The drug's effects were demonstrated in a large trial (funded by Bayer) the results of which were published in The Lancet's July 5 issue. [The Lancet abstract] [The Lancet commentary (subscription required)]
Prosthetic ears?! [Medical News Today] [Archives of Facial Plastic Surgery]
A fascinating take on 23andMe, a DNA testing company, and the potential future of personalized medicine -- as well as social networking. [New York Times]
Here's the latest and greatest from blogs written by Canadian physicians:
In "A Bird's Eye View of Family Medicine," a retired Okotoks, Alberta, family physician, who ponders our country's health policy problems at What's Wrong with Healthcare?, writes:Over the past four to five days I have noticed that my budgie bird, Jo-Jo, was becoming a “Star Gazer”. In medical terms, he was developing a torticollis. Now to appreciate the story, you should know that I inherited this bird from an elderly couple in my practice, when during a house-call, they asked if I would take Jo-Jo if anything ever happened to them. They said he liked me, and besides, their daughter had a cat. In a moment of insanity (my wife hated birds), I agreed. Some two years later both of these dear elderly folks passed on and I prayed that they told no-one of my promise. Unfortunately, the daughter showed up in my office a few days later with bird, bird cage, bird food, and various other bird paraphernalia. My wife was not pleased and I barely escaped the couch the first night.
The budgie's neck problem leads the author to a novel solution to the shortage of primary care providers in Canada, believe it or not. (I'll give you a hint: more money.) [What's Wrong with Healthcare?]
Alberta Liberal leadership candidate and former public health physician David Swann on the environment and health: they're "two sides of the same coin," he says. [David Swann's Blog]
Dr Michelle Greiver dissects the debate on hosting electronic medical records locally vs remotely. [Dr Greiver's EMR]
Speaking of electronic medical records, CanadianEMR just introduced its weighted medical records software rankings, vastly increasing the value of its already impressive user-rating system. [CanadianEMR]
Tuesday, September 16, 2008
CMA issues healthcare challenge to political parties
In an open letter sent today to the leaders of the five largest political parties, Canadian Medical Association president Robert Ouellet (right) demands responses from each on the six most pressing healthcare problems facing the country today.
As well, Dr Ouellet asks each party to release their healthcare platform by September 29 at the latest so the public has time to weigh the different proposals before the election on October 14.
The CMA won't endorse anybody, but the party's platforms and their answers to the CMA's questionnaire will become part of the organization's Voter's Guide, to be published October 3 at www.cma.ca/election2008.
The six healthcare problems that Dr Ouellet wants to know the party's positions on are:- the doctor shortage
Before October 3, when the Voter's Guide will come out, the CMA is providing election coverage for physicians at www.cma.ca/election2008.
- mental health
- innovation and information technology
- access to prescription drugs
- health and the environment
- sustainability of the health care system
Photo: CMA
Electioneering
With the election campaign gearing up and the leaders hopping back and forth across the country in search of votes -- but with still only a few mentions of health policy thus far -- I decided it would be a good idea to find out when the major political parties' healthcare platforms would be available, to help plan our coverage. So I made a few calls.
The young man who answered the phone at the Liberals' media relations office had the answer at the ready: the full platform will be available on September 22 -- next Monday.
The Green Party informed me their platform comes out on September 17.
The NDP's media relations department couldn't give a specific date for the release, but they were very accommodating about putting my name on the list of reporters to be notified when the platform is published.
The Bloc Québécois, which doesn't really have any obligation to draft a full health platform beyond reiterating their mission to extract as much funding as possible from Ottawa, has already made public their entire election platform. (Other than a timely section on food-safety inspections and a few other sensible but predictable concerns, healthcare doesn't play a terribly large role in the Bloc's platform.)
And the Conservative Party -- which has been at odds with the national news media for some time now -- was not only unwilling to give me an idea of the date when their healthcare platform would be released. In addition, their media relations officer told me that there would be no point taking down my name and contact information, because the Prime Minister will be rolling out parts of the party's platform as the campaign progresses and I'll hear about it when he announces it. End of conversation.
What's in the news: September 16 -- Ranking the provinces, rural reluctance and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 16.
The Frontier Centre for Public Policy, an independent think-tank based in Winnipeg, released its first Canada Health Consumer Index, which ranks the provinces' healthcare systems rank as follows:1. Ontario
A short mention of the Frontier Centre study on the St John's Telegram's website has already attracted a number of angry comments, lambasting Newfoundland and Labrador premier Danny Williams. [The Telegram] [Full study available as PDF from the Frontier Centre for Public Policy]
2. British Columbia
3. Nova Scotia
4. New Brunswick
5. Alberta
6. Prince Edward Island
7. Manitoba
8. Quebec
9. Saskatchewan
10. Newfoundland and Labrador
As Liberal leader Stéphane Dion's campaign continues to struggle, speaking at Dalhousie University's medical school (where Jack Layton announced elements of his proposed health human resources plan yesterday) Mr Dion this morning announced that his government would create a national catastrophic drug coverage plan. This is a promise Canadians have heard before from federal politicians -- and the premiers are all for it -- but still no progress has been made. [CBC News]
The parents of an ill nine-month-old child, who was very underweight and suspected by staff Toronto's Hospital for Sick Children of being malnourished, were arrested yesterday after a week-long search across the city. The child was taken into the custody of the government's Children's Aid Society. It turns out the parents are members of a "religious sect" (The Globe and Mail was careful not to use the word "cult," for sensitivity reasons, one assumes) called the Nation of Moorish-Americans, which seeks to unite North American "Free Negroes" are really citizens of Morocco. "She's not an evil person and she's not a bad mother... We have the rights as Moorish-Americans not to succumb to institutionalized ways of healing ourselves," said her "spiritual leader" Grand Sheik Brother Kudjo Sut Tekh El. [Globe and Mail]
An Ontario coroner's inquest began yesterday, to investigate the death of Jeffrey James. Mr James died at the Centre for Addiction & Mental Health in Toronto in 2005 after he was tied down to his bed for five days in a row because he had engaged in a "sexual act" in the hospital. Ontario's chief coroner has testified that Mr James died as a result of blood clots that reached his lungs, caused by his being tied down. [Globe and Mail]
Acyclovir, long believed to be useless in HIV but effective in controlling the herpes virus, can actually attack HIV in patients with both that virus and herpes, according to a new study published in Cell Host and Microbe by an international team of researchers including one from McGill. [Cell Host and Microbe abstract] [McGill University]
Saskatchewan's nurses' union has filed a Charter challenge against the province's essential services legislation, which was passed by the recently elected Saskatchewan Party majority government earlier this year. [Canadian Press]
A Quebec group advocating a provincial newborn hearing-screening program congratuled several Montreal hospitals on their decisions to begin screening programs, but urged the government to follow suit across Quebec. [Montreal Children's Hospital/McGill University]
Dr Trevor Theman, the registrar of the College of Physicians and Surgeons of Alberta, is nervous about this past summer's agreement (PDF) by the Council of the Federation, the assembly of Canadian provincial premiers, on labour mobility for professionals including physicians. In the September issue of the College's newsletter, The Messenger, Dr Theman writes:I am very concerned that the premiers’ direction addresses one social good, that of labor mobility, but ignores (and may destroy) another - that of ensuring we have physicians working in rural, remote and underserviced parts of Canada. [...]
What might happen if free, unfettered labor mobility is mandated? Well, Newfoundland, Saskatchewan, rural Manitoba and northern Alberta may find themselves with no (or significantly fewer) physicians. [CPSA Messenger (PDF, page 3)]
The chemical found in many plastics, Bisphenol A (BPA), has deleterious health effects if it accumulates in humans, according to a new study published today in JAMA. Potential risks include heart disease, liver problems and diabetes. Canada has already restricted the use of BPA, labelling it a "toxic chemical" in April, but the United States has not done so yet. [JAMA editorial] [Washington Post]
New data from the DIRECT Program, described as "the first large-scale study program assessing the effect of treatment with an angiotensin receptor blocker (ARB) on the incidence and progression of diabetic eye complications," shows moderately positive signs on the potential benefits of prescribing the drug candesartan to Type 1 and Type 2 diabetics. Type 1 patients who had diabetic retinopathy at the start of the trial didn't get any help from the drug, but diabetics in the test group who had early signs of the disease or who hadn't yet contracted it saw up to one-third better outcomes than those in the placebo group. The study shows some promise for microvascular treatment solutions for diabetic retinopathy. Renowned Montreal General Hospital endocrinologist/internist Robert Gardiner is one of the international coordinators of the trial. The new data was presented last week at the European Association of the Study of Diabetes congress in Rome, and a full article is to come soon in The Lancet. [Takeda UK, AstraZeneca Canada, and others]
Remember the infamous Walter Reed Army Medical Center scandal exposed by the Washington Post? Mother Jones magazine claims to have uncovered another military healthcare snafu: the Pentagon's $20-billion electronic medical records system, which now allegedly lies in shambles. [Mother Jones]
Monday, September 15, 2008
More details on the tentative Ontario doctors' pay agreement
Canadian Medicine has obtained a copy of today's message from Ontario Medical Association president Dr Ken Arnold to the association's members, announcing the endorsement of the tentative agreement with the government. Here it is, in full:From: Ontario Medical Association
Sent: Mon 15/09/2008 09:52
To: ---------------
Subject: President's Update: Tentative Agreement Reached!
OMA President's Update
Volume 13, No. 24
September 15, 2008
Tentative Agreement Reached!
Dear Colleague:
The OMA Board of Directors has unanimously endorsed a tentative four-year Physician Services Agreement with government. Our Negotiations Committee presented a proposal to the Board for review late last week. After very careful consideration, the Board has voted unanimously to approve the offer, and recommend it to members.
The purpose of this bulletin is to notify you that we have a proposed contract - we wanted to ensure that you hear it from the OMA first!
The fee component of the Tentative Agreement provides for a 12.25% increase in fees over the term of the Agreement. The amount available in each year for fee adjustments is as follows:
October 1, 2008 3%
October 1, 2009 2%
October 1, 2010 3%
September 1, 2011 4.25%
One-half of the fee adjustment will be allocated to each OHIP specialty on an equal percentage basis. The remaining half of the adjustment will be used to correct disparities in intersectional relativity. Non-fee-for-service physicians will receive an equivalent adjustment on payments for clinical services.
The Tentative Agreement also includes an additional $240 million in new ongoing program funding, and an additional $100 million in one-time incentive funds.
Program changes include:
(Complete details of the new program and incentive funds will be set out in the Executive Summary.)
The Tentative Agreement will deliver approximately $1 billion in new funding to Ontario physicians, including fee changes, alternate payment plans and programs.
This has been a difficult negotiation. Government took a very tough stance on a number of our priority issues. We maintained our strategic focus, and the OMA Negotiations Committee effectively advanced our position. Just recently, we achieved movement at the table that resulted in the current proposal.
We are now mobilizing to develop documents, arrange for member information sessions, and implement plans for a member referendum and special Council meeting. The legal team is finalizing the drafting of the contract.
All information will be posted in the Negotiations 2008 Member Resource Centre on the OMA website as soon as possible (https://www.oma.org/members/negotiations/). We will provide summary documents, a Q & A file, and frequent updates via the OMA e-mail and fax network. We expect the initial materials will be available Wednesday, September 17.
You will be hearing from us often. A schedule of member information sessions will be circulated to the profession. We are working to arrange as many meetings as possible to allow for face-to-face discussions about the proposal.
We will establish as many communications channels as we can to allow for members to get what you need to make an informed decision.
The Board anticipates that the member referendum will take place October 8-15. We are hoping to provide members the option to cast their vote either by telephone or online. A Special Meeting of Council will be held October 18.
On behalf of the Board, I want to thank all of our members for your patience and support throughout the negotiations process. I also want to thank the members of our Negotiations Committee for their diligence and commitment on behalf of the profession.
The Board is very pleased that we have achieved a Tentative Agreement that received unanimous endorsement. We will be bringing you all the information that you need to interpret the value of this proposal for your practice.
Dr. Ken Arnold
OMA President
Feedback public_affairs@oma.org
After long delay, Ontario MDs are offered a 12% raise
Five and a half months late, a proposed contract has finally emerged from the negotiations between the government of Ontario and the province's doctors.
According to a report by the Canadian Press today, the new contract would give Ontario's physicians a 12.25% raise over the next four years, plus an additional $350 million in special program funding.
The contract, however, must still be approved by the Ontario Medical Association's membership in an October 18 vote, and if past experience is any guide then there is no guarantee the OMA's members will approve the deal. During the last set of negotiations, in 2004 and 2005, doctors refused to endorse the first contract proposed by the government; the process to agree on a revised deal became heated and soured many Ontario physicians on then-Health Minister George Smitherman, who was transferred to the Ministry of Energy and Infrastructure in June.
Though the negotiations leading to today's proposal dragged on over a long period of time -- the previous contract expired on March 31 -- they haven't been as heated as 2004/2005 negotiations. The CP article notes that an OMA source called the process difficult and said the government took a "very tough stance."
UPDATE, 4pm: The Ontario Ministry of Health and Long-Term Care has issued their press release on the tentative agreement. Health Minister David Caplan is quoted as saying: "This agreement will allow us to continue moving forward by focusing on our top priorities: improving access to family care and reducing wait times."
UPDATE, 5pm: A 12.25% raise over four years may sound generous, but there's another way of looking at that figure. The average annual raise promised in the proposed contract amounts to 3.0625%. Compare that to the Canadian inflation rate as reported by Statistics Canada for the last two months data are available: a 3.1% inflation rate in June 2008, and a 3.4% inflation rate in July 2008. The nation's inflation rate is variable, of course, but consider the fact that over the last four years Canada's average inflation rate has been 2.48% -- not far from the 3.0625% raise proposed today. If one assumes that inflation rates over the next four years -- the term of the new Ontario agreement -- remain as they have been over the past four, then Ontario doctors will be getting an inflation-adjusted pay hike of just 0.5825%.
What's in the news: September 15 -- Religion, suicide, addictive energy drinks and more
A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 15.
Healthcare will be a major issue in this week #2 of the federal election campaign, pledges Canadian Medical Association president Robert Ouellet. Voters go to the polls on October 14. [Summerside Journal Pioneer (PEI)]
The Ontario Medical Association is taking a stand against a draft policy by the College of Physicians and Surgeons of Ontario that would warn doctors that changes to the functioning of the province's Human Rights Commission may mean that doctors will no longer be able to refuse to provide certain types of medical services (such as abortion referrals) on religious or moral grounds. According to the OMA, the document should note that doctors' "right to freedom of religion is protected under the Charter of Rights and Freedoms." [OMA] [National Post]
Newfoundland and Labrador's three gynecological oncologists won't be leaving quite yet. The province's only three such specialists warned that because of poor working conditions they would be leaving on October 7, but that date has now been pushed back to December 15 at the earliest because of delays in notifying patients of their imminent departures. [CBC News]
Newfoundland and Labrador faces other problems as well: physicians are complaining that the lack of operating-room time is "a very desperate situation." [CBC News]
The hospital centre affiliated with the University of Montreal -- CHUM -- is outsourcing all its ophthalmology work to the private sector. [Le Devoir]
Garou, the Quebec pop singer, has proposed creating a $100-million private health clinic across the street from the site where the planned CHUM French-language Montreal "superhospital" is supposed to be built (assuming all the parties end up agreeing on the site). [Le Devoir]
Canadian Family Physician looks at physician suicide in "The wounded healer." [CFP] Read the National Review of Medicine's 2007 article on the same subject. [NRM]
The Archbishop of Montreal, Jean-Claude Turcotte, has returned his Order of Canada medal in protest of the award being given to Dr Henry Morgentaler earlier this year. Dr Morgentaler is largely responsible for the full decriminalization of abortion in Canada, in 1988. [Bloomberg]
Last week, an LA Times blog reported that US Republic Party vice-presidential candidate Sarah Palin's much-publicized decision not to abort her son Trig, who was given a prenatal diagnosis of Down syndrome, may reduce the number of Down syndrome abortions -- which would be a negative development, according to Society of Obstetricians and Gynecologists of Canada executive VP Dr André Lalonde. However, the Times was forced to retract their story after it became clear that Dr Lalonde (who was quickly vilified all over the internet) was actually saying that he worried Ms Palin's decision could influence the decisions of mothers who are not prepared for the challenges of raising a Down syndrome-afflicted child. Read the original quotes from Dr Lalonde in The Globe and Mail.
The RCMP has charged an unnamed North Battleford, Saskatchewan, physician with "counselling to commit drug trafficking." The doctor is set to appear in court tomorrow. [Canadian Press]
Energy drinks should be banned in PEI, says the president of the Medical Society of Prince Edward Island, Dr William Scantlebury. A New Brunswick neurologist says a ban on sales of energy drinks to children across Canada would be prudent. [Moncton Times & Transcript]
Check out the new information-technology handbook published by the Canadian Medical Association. [CMA] [CMA News]
A Toronto-based physician and researcher from the Centre for Addiction & Mental Health has traced the neurotransmitter levels involved in seasonal affective disorder. The study is published in this month's Archives of General Psychiatry. [Archives of General Psychiatry] [MedPage Today] [The Globe and Mail]
Novelist Jennifer Egan explores the "bipolar puzzle" in children, in an excellent article in yesterday's New York Times Magazine. [NYT Magazine]
Asteroid 84928 is hereby named Oliversacks. [New York Times]
Friday, September 12, 2008
What's in the news: September 12
A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 12.
The methadone kickbacks scandal in Vancouver's Downtown Eastside could lead to criminal charges and reforms to the province's methadone dispensing system, BC Health Minister George Abbott told CBC News. [CBC News]
Nunavut's health minister, Leona Aglukkaq, has stepped down from her territorial duties to run for the Conservatives in next month's federal election. [CBC News] Ms Aglukkaq wasn't widely popular in her job as health minister in Nunavut and was long rumoured to be on her way out. [Nunatsiaq News]
A rethink of the necessary number and location of hospitals in Ontario's Niagara region has residents and doctors up in arms. [Niagara Falls Review]
Women who work for women suffer 20% more mental and physical problems than women who work for men, according to a new University of Toronto study on relational demography in the workplace. [Journal of Health and Social Behaviour] [Globe and Mail]
Thursday, September 11, 2008
What's in the news: September 11
A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 11.
Today marks the seventh anniversary of the terrorist attacks in New York City, Washington, DC, and Pennsylvania, and health reporters around the world have filed related stories.
The location of Montreal's long-planned French superhospital is at the centre of (yet another) fight between the province's medical specialists union and the government. The current disagreement, according to Health Minister Yves Bolduc, threatens to delay the already delayed project by up to a further five years. [Montreal Gazette]
Dr Jerry Richard, who just moved to Nipawin, Saskatchewan, a week ago, is holding a lottery to determine which patients will be accepted into his practice. The College of Physicians and Surgeons of Saskatchewan seems to be okay with the idea. [Canadian Press]
The Agriculture Department of Quebec is under fire for its "draconian" anti-listeriosis decisions, including cheese-discarding fromagerie raids. [Canadian Press]
A McGill professor claims Canada's outdated and flawed intellectual property and patent laws are pushing us towards a pharmaceutical crisis. "If things don't change, we're going to all have fewer medicines to treat whatever the next diseases are," E Richard Gold says. [The Globe and Mail]
British Columbia will not introduce new limits on drug company's gifts to doctors, says Health Minister George Abbott. CMA President Dr Robert Ouellet sees no problem with that. [Georgia Straight]
Canada's public drug plans rank near the bottom of 18 surveyed developed countries, according to the new Wyatt Health International Comparison Study. [Wyatt Health Management]
What distinguishes large hospitals from small ones, from a Canadian doctor's perspective: no free parking, interminable waits for the elevator, cell phones don't work inside the building, and more. [Med Valley High]
Arthrospocic surgery for knee osteoarthritis is of no use, report researchers in the New England Journal of Medicine. [NEJM] [LA Times] The study, which has garnered a great deal of international attention, was conducted by researchers from the University of Western Ontario. [UWO]
Is it moral to use drugs to improve people's ethical behaviour? [British Journal of Psychiatry abstract] [Mind Hacks]
Wednesday, September 10, 2008
Canadian physician blogs
Our list of blogs written by Canadian physicians, residents and med students now features 55 entries.
Among the blogs on our list are those written by politicians like Dr Carolyn Bennett and Dr David Swann, clinical information blogs, blogs about parenting, electronic medical records, medical jokes, and lots more.
To check out our list, just check the right-hand sidebar "CANADIAN PHYSICIAN BLOGS" and click the [+] button to get links to all 55.
Or, see below for a full listing.
(If you are a Canadian doctor and your blog isn't on our list, or you know of a blog that you think we should include, please let us know.)
What's in the news: September 10
A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 10.
Pharmacists are paying heroin users anywhere from $5 to $20 to take methadone in order to cash in on the big dispensing fees, claims a senior physician with the government's Vancouver Coastal Health Authority. [Vancouver Province] One pharmacy, called Gastown Pharmacy, is accused of threatening to evict methadone users from the nearby hotel it owns if they break an agreement to get the drug only at that pharmacy. A CBC News reporter looking for a comment was asked to leave. [CBC News] The College of Pharmacists of BC and the provincial ministry of health are conducting investigations, but the opposition NDP was frustrated to learn that the government knew about the allegations of kickbacks as long ago as January. [Vancouver Sun]
The listeriosis body count reaches 14, with another death in Ontario. [Associated Press]
Canada's first physician assistant training program begins this week at the University of Manitoba. [Province of Manitoba]
Quebec plastic surgeon Denis Bisson has been brought in front of the province's College of Physicians and Surgeons disciplinary committee for performing a banned breast augmentation technique that allegedly had no lasting effect. Dr Bisson has pleaded not guilty, and the results of the hearing haven't been determined yet. [La Presse (French only)] [CJAD (English summary)]
Islanders: don't forget that your Medical Society of PEI annual general meeting is starting on Friday. Don't miss the "What's up with your big 'ol head" session, the "possible" pool party, and the Lobster Smorgasbord/Half a Cow, followed by a jam session and after-hours time in the games room. [MSPEI]
Nunavut is shooting for 2012 to have their patient records in electronic format. [Canada Health Infoway]
Today is International FASD Awareness Day, to inform people about fetal alcohol spectrum disorders. [fasday.com]
Pay-for-performance incentives in medicine can backfire sometimes, an American physician (who's experienced just that in a suspected case of pneumonia) writes. [New York Times]
Should doctors wear long sleeves or short sleeves? The debate centres around professionalism vs. infectious disease control, but not everyone is convinced there's any practical benefit of going sleeveless in terms of reducing infection rates. [New York Times]
23andMe, a Google-affiliated San Francisco firm that offers personal DNA tests, has cut its prices from $999 to a bargain-basement $399. [Associated Press] Paying a geneticist to interpret the mass of largely useless data you get back from the company, however, is going to run you a lot more than a few hundred dollars... it is a cool idea though.
Also, here are four medicine-related gems from yesterday's Harper's Weekly Review, by Claire Gutierrez:
Xiguang, a four-year-old elephant also known as Big Brother, is headed home after three years in a detox program to help him kick a heroin addiction that began when he was kidnapped and fed dope-laced bananas. [Reuters]
A British teenager was hospitalized in Greece when her face swelled "to the size of a football" after drinking a cocktail of "Baileys, chilli, tequila, absinthe, ouzo, vodka, cider and gin." She'll never drink again, she said. [BBC News]
Four readers of the Swedish food magazine Matmagasinet suffered from nutmeg poisoning as a result of an error in a recipe for apple cake. [New York Times/Freakonomics]
Playing a didgeridoo can cause female infertility, said an Australian aboriginal group. [Agence France-Presse]
Tuesday, September 9, 2008
Anonymous blogging: Don’t do it
(This article is adapted from my presentation in the medical bloggers’ panel at the Medicine 2.0 Congress on September 4 in Toronto, Ontario.)
To explain the danger of doctors writing anonymously online, I want to present the case of one of medical blogging’s first casualties, a pediatrician named Robert Lindeman (left).
Dr Lindeman went to Yale and then did his MD and PhD at Columbia. He worked at the Children’s Hospital in Boston, which is known as one of the best, if not the best, pediatric care facilities in the world. He now works as a pediatrician, with a specialty in asthma and pulmonary diseases, in Natick, which is an affluent suburb of Boston.
In 2002, a 12-year-old patient of Dr Lindeman’s died of diabetes complications -- a condition called diabetic ketoacidosis, in which the body essentially self-destructs because of a chronic lack of insulin. It’s most common in young patients with type 1 diabetes whose disease goes undiagnosed and untreated. The 12-year-old, whose name was Jaymes Binns, saw Dr Lindeman at his Natick office six weeks before he died. Dr Lindeman didn’t diagnose Jaymes with diabetes. The family sued.
Meanwhile, there’s another aspect to this story. Dr Lindeman, who’s smart, gregarious and funny, loves to write. And he’s a good writer. Being a doctor is what he knows, and they always tell you to write what you know, so he wrote what he knew. In 2006 -- the Binns case still unresolved -- he got on the internet and started a blog. You may not have known Dr Lindeman’s name before, but many will recognize his former nom de blog: “Flea.”
Last year I wrote an article for the National Review of Medicine, titled “Check my blog and call me in the morning” about the growing doctor blogging phenomenon, and I talked to Dr Lindeman.
He explained to me that Flea wasn’t just a blogging pseudonym -- he was a sort of alter ego, to some extent. What Dr Lindeman couldn’t say, Flea could -- and did. Dr Lindeman told me:“There has been a certain amount of blunting of messages that are difficult for a doctor to say. For a pediatrician to say most visits to a pediatrician’s office are unnecessary, for example. It’s a stupid thing for a person practising medicine to say, but Flea could say it and explain why and make an argument.”
(A transcript of my interview with Dr Lindeman is available here.)
Flea became a fixture of the medical blogging world. He became popular, known for straight talk, for saying the kinds of things that I think a lot of doctors wished they could say.
Fast-forward now a little bit, to spring 2007, Suffolk County Superior Court, in Boston.
The Jaymes Binns case didn’t settle and it eventually reached trial. Throughout the proceedings, Dr Lindeman is sitting in the courtroom and at the end of the day, he goes home and Flea starts blogging.
I’ll read to you a few things Flea wrote about the case. This is from his notes on jury selection:“The jurors really really didn't want to be there. The poor young woman sitting in seat number one looked as though she wanted to jump out the window when she realized she was actually going to be impanelled. Some of the jurors appeared to be sleeping by the end of the selection process. Flea trusts they will remain awake during the actual proceedings.
You get the idea. It’s not pretty. (In fact, I opted not to read these things out loud at the Medicine 2.0 Congress last week.) And that wasn’t all -- Dr Lindeman also discussed and reproduced some of his communications with his lawyer about their preparations and defense strategy.
“Flea was able to form an opinion of the plaintiff's attorney (we'll call her Carissa Lunt). Attorney Lunt has not an ounce of fat on her body. Her features are sharp and angular and not particularly pleasant. You don't get a warm and fuzzy from her. She has no sense of humor. You know when you overhear someone chit-chatting and she tries to say something funny and it really isn't and nobody laughs? That's her. Attorney Lunt bites her fingers. In court. She's a finger-biter. Wonder if she's a pillow biter too?”
One blogger, Eric Turkewitz, a malpractice lawyer in New York who writes at NewYorkPersonalInjuryAttorneyBlog.com, pointed out at the time how dangerous Flea’s blogging was, and wondered whether he would be found out, and what the result would be, whether the blog could be introduced during the trial. Well, it turned out Mr Turkevitz was prescient.
I’ll read briefly from a 2007 Boston Globe article on what happened:It was a Perry Mason moment updated for the Internet age.
Just like that, Dr Lindeman became the poster boy for the legal dangers to doctors of blogging.
As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.
Was Lindeman Flea?
Flea, jurors in the case didn't know, was the screen name for a blogger who had written often and at length about a trial remarkably similar to the one that was going on in the courtroom that day.
In his blog, Flea had ridiculed the plaintiff's case and the plaintiff's lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing.
With the jury looking on in puzzlement, Lindeman admitted that he was, in fact, Flea.
The next morning, on May 15, he agreed to pay what members of Boston's tight-knit legal community describe as a substantial settlement -- case closed.
After the case ended and the Globe article came out, Flea disappeared and a lot of physician-bloggers were left shaking in their scrubs.
I asked Dr Lindeman about what effect he thought his case had on other doctor bloggers, and he said:“The scuttlebutt I have been hearing is that it has had a chilling effect, and that makes me feel terrible. I try not to think about it, it makes me feel so bad that I am responsible. I’m inclined to think it is true, but I desperately hope it’s not true.“
But it was true -- the chilling effect was real. All of a sudden, the dangers of blogging became a hot topic in the medical journals. The Canadian Medical Association Journal and the American Medical Association’s newspaper both recently ran articles about the dangers of blogging.
The CMAJ’s article was titled “Online medical blogging: don’t do it!” I’m not entirely sure the authors had a grasp of the subject matter all that well -- isn’t online blogging redundant? -- but they sure as hell made blogging sound scary. Listen to this part:“Why would you, as a physician, put yourself in a precarious position by posting personal feelings, opinions, and attitudes on a public website? Material that may seem innocent enough at the time of posting may come back to haunt you at any point in your career, by any person you have or have not yet met — weeks, months, years or even decades down the road. And, you cannot know who may have — or develop — a grudge against you. The people you may be writing about are patients with illness. They may be emotionally vulnerable or even unstable. As such they may seek to contact or confront you outside the work place. Giving those people a permanent electronic record about yourself may allow them to pursue you in ways you will not like.”
What exactly are they warning about? Has any doctor yet been stalked by a blog reader? Certainly not that I've heard of.
Anyways, my message is that all those dangers the academics are warning about are overstated.
I have a theory about the Flea case that I think explains where all the blogging fear comes from, and it all comes down to anonymity. Instead of protecting Dr Lindeman, the attempt at anonymity ended up ruining him. Here’s my diagnosis of Lindeman.
People liked reading what Flea had to say, they called him brave, they called him bold. He won a medical blogging award in 2006. My reading of the situation is that Dr Lindeman was having a good time, that he was enjoying it. I think it’s clear that Lindeman got emboldened and went further than he might have been if he had not been anonymous.
I think the most telling piece of information here is that Flea rather oddly referred to himself in the third person, a sort of weird Bob Dole thing. Maybe that doesn’t mean anything, but I think -- maybe not consciously -- Dr Lindeman saw Flea as somehow different than him. If you’re so inclined, it’s still possible to track down a full record of Dr Lindeman’s blog, even though he took it all offline last year. If you take a look through all his posts, you’ll notice a lot of photos and illustrations of scantily clad women and unnaturally busty female cartoon characters. Is that something a well respected Columbia University MD/PhD who publishes in academic journals would do if he thought readers would find out it was him? Certainly not.
When we were talking about his writing on malpractice law, Dr Lindeman told me, “The reason I blogged about it was to bring the id out into the public, to explain that this is something we are consumed with.”
I think his mention of the Freudian concept of id is appropriate to his case -- his id, which he called Flea -- got the better of him and (if you’ll forgive me for continuing this line of pop psychology thinking a bit further) his id dominated and eventually conquered his superego. And look what happened to him.
Another lawyer-blogger, a Texan named William J Dyer, had a similar diagnosis last year when the story broke. In a post titled “Self-immolation on the witness chair via the power of the internet” Dyer wrote of Dr Lindeman’s folly: “Willful but subconscious self-destruction, possibly coupled and overlaid with a God-complex.” The runaway id, again, in a way.
As I said before, Dr Lindeman is a smart guy in many regards but in some ways he’s not always a very polite or prudent guy. Here’s what he told me about writing, when I asked him to think back about his experience:“Anytime you write something in print, you need to expect someday it is going to be read to you in court. The most innocuous thing I ever wrote -- it was a description of the immunization schedule, on my official website -- was read to me by the attorney to make me look like a schmuck. How much more so something incendiary, then? No wonder when doctors write they write namby-pamby noncommittal crap -- it might get you in trouble someday.
But Dr Lindeman is wrong, and I think if you really pushed him to admit it, he would say that the real problem, ironically, was the anonymity.
“One solution is not to write at all. I’m not sure if it’s possible to be careful -- that’s the reason why I told you about the immunization schedule. I bristle at the suggestion that there’s a way to do this that is right, if by right you mean safe. Writing as a physician is a dangerous activity, and that’s a shame. That’s a message I’d like the folks to know. For physicians, writing is dangerous and there is something really messed up about that.”
The lesson from the Flea saga is that the real danger is not writing -- it’s writing anonymously. Anonymity gives you licence -- or at least, it feels that way -- to write about things you know you really ought not to be writing about at all -- like protected information about your preparations for a malpractice trial, as in Dr Lindeman’s case, or about a specific patient who could potentially be identified because of your writing. When you’re anonymous, it’s far too easy to say something without regard for its potential consequences to you -- the assumption being, incorrectly, that there will be none.
Anonymity online is all but impossible nowadays, and many internet users have been slow to realize that. And it’s not just people without internet experience: remember a few years ago when The New Republic’s Lee Siegel got caught posting supposedly anonymous comments praising his own writing under the name “sprezzatura”? When I was writing my article on doctor-bloggers, I managed to get the names, addresses and phone numbers of a handful of Canadian doctors who thought they were anonymous -- at least one of whom wasn’t very pleased to hear from me and refused to comment. It only took me a short amount of time to get that information, and I’m just a journalist at a small Canadian magazine with no special computer programs or knowledge.
But things are looking up. According to a new report on the health blogosphere, released last week by Envision Solutions, the number of health bloggers writing anonymously has dropped by nearly half from 2006 to 2007, from 38.7% to 19.7%. The report’s authors attribute the decline to the Flea case, and another case involving an Australian surgeon who shut down her Barbados Butterfly blog in 2006.
I’m happy to report that despite the scandals and the widespread warnings from academic journals, it seems like the number of doctors getting into blogging keeps rising, and I think that’s a good thing.
Jeffrey Goldberg, an excellent writer currently with The Atlantic, when he began blogging earlier this year, posted this self-depracatory little note:“Friends tell me that I will take naturally to blogging because I am in possession of many poorly considered opinions about issues I understand only marginally.”
As someone who also has many such opinions, I say: good! Doctors’ opinions are valuable. But doctors’ opinions have been conspicuously missing from public discourse, during an era in which healthcare delivery and health policy are increasingly important to the public, and when the public is better informed about medicine than ever before. Whether doctors’ blogs are filled with poorly considered opinions, or long-form researched essays, or crass jokes, or political polemics, or what have you -- all of those things are valuable because they encourage discussion and debate.
Whether a doctor’s blog helps by letting her vent a little bit or letting you explain how she feels, or if your topic is primary care remuneration, or health insurance law, or, as in Flea’s case, tort reform -- whatever the subject, blogging is a positive development in medicine and something that doctors should not and must not abandon because of some medical association analysts’ largely unfounded fears. So blog away, doctors... just don’t do it anonymously.
Photo: Robert Lindeman, Natick Pediatrics
CMA Annual Meeting 2008 resolutions: The top 15
Doctors were busy at last month's Canadian Medical Association annual meeting in Montreal, producing 99 policy resolutions. That doesn't quite match last year's count of 108, but it's pretty close.
As we did last year, Canadian Medicine has created a listing of what we feel are the 15 most important resolutions -- a more manageable number than 99.
(If you want to read all of them, you can find them on the CMA's website: Monday, Tuesday and Wednesday.)
The top 15 are as follows, listed in the order in which they were adopted. (My comments and suggestions for further reading are appended to the end of each item, in italics.)
Mental health stigma and reform
The Canadian Medical Association urges Canadian physicians and their organizations to work together to transform patient care for people with mental illnesses through a strategy, including but not limited to:
a. fighting the stigma that exists in our own profession and physician organizations;
b. advocating for parity of allocation of resources toward the continuum of mental health care and research;
c. promoting an evidence-based mental health system anchored on:
* strong primary care networks,
* community-based care,
* team-based and multidisciplinary care in a public system,
* adequate social policy supports such as housing and income, and
* the involvement of primary care and specialist physicians in the planning processes.
Read my recent blog post on this subject for more.
Physician wellness
The Canadian Medical Association will develop and implement a strategy that supports the mental health of Canada’s doctors.
“Transformational change”
The Canadian Medical Association (CMA) will develop a blueprint and timeline for transformational change in Canadian health care to bring about patient-focused care with a report to the CMA Board in February 2009.
P3s
The Canadian Medical Association will develop a policy framework and principles for public-private partnerships in the capitalization, management and delivery of publicly funded health services in Canada, based on an evaluation of experiences to date in Canada and abroad.
The evaluation of experiences to date should be very interesting. I’m sure many healthcare policy analysts and politicians -- on both sides of the aisle -- will be nervous about how that will turn out.
Patient-focused funding
The Canadian Medical Association supports the concept of patient-focused funding for hospital services as one alternative to global budgets [block funding] to enhance efficiency and effectiveness of health services delivery and organization.
I wrote about the push towards patient-focused funding in the National Review of Medicine last year.
Canadian Patient Alliance
The Canadian Medical Association and provincial/territorial medical associations shall facilitate the creation of a Canadian Patient Alliance that will represent the needs and interests of Canadians on health-related issues.
Some very astute reporter (not me) wondered aloud during one of the press briefings about what a physician association was doing creating a patient association. Good question. No details yet on what this Canadian Patient Alliance actually means.
Post-traumatic stress
The Canadian Medical Association will work with the Department of National Defence to provide high quality evidence-based mental health services to Canadian Forces members and their families resulting from operational stress injury including post-traumatic stress syndrome.
There was a fair amount of debate on this motion at the meeting. A physician with the Canadian Forces stood up to defend the military’s PTSD screening and treatment program, and there was some disagreement back and forth about how the screening program worked and whether it conformed to evidence-based research.
Jordan’s Principle
The Canadian Medical Association supports Jordan's Principle which states that where government services are available to Canadian children and a jurisdictional dispute arises around the cost of the services for Status First Nations and Inuit Indian children, the government of first contact pays the cost then resolves the jurisdictional dispute later.
A 2007 CMAJ editorial summed up the issue well.
Just last Friday, the federal government and the government of Manitoba finally came to an agreement to implement “Jordan’s Principle” in practice.
Governance review
The Canadian Medical Association adopts the Board of Directors’ final report and recommendations on governance review as outlined in Appendix 1 to the 2008 Reports to General Council.
One of the changes included in the governance review is a far smaller board of directors of the CMA. Click here for more on the CMA’s governance reforms.
Religion and gender discrimination
The Canadian Medical Association opposes all forms of gender discrimination exerted against Canadian physicians and trainees as a result of pressure from patients or their families seeking the application of measures or practices dictated by their religion or culture.
This can be a touchy subject, so there was quite a hubbub when this motion, proposed by Quebec Medical Association president Jean-Bernard Trudeaeu, came forward. A CMA report on the debate quoted him saying, “Because of the values that are of a religious nature, in some communities... men with profound religious beliefs want their wives to be examined by a woman doctor and do not want any intervention by a male doctor, even if the security of a delivery (of a fetus) is compromised.”
Harm reduction
The Canadian Medical Association calls upon the federal government to reverse its decision to appeal the British Columbia Supreme Court's decision that would allow Vancouver's supervised injection site (INSITE) to remain open.
Insite was a hot issue at the CMA annual meeting this year: Health Minister Tony Clement’s speech to the delegates was in large part a criticism of physicians’ majority opinion of Insite and other harm reduction strategies. Mr Clement called doctors’ support for harm reduction “unethical,” prompting angry responses from CMA members and opposition politicians. For more on the federal government’s appeal of the court’s Insite decision, read Canadian Medicine’s extensive coverage.
Telehealth jurisdiction
The Canadian Medical Association, in consultation with provincial/territorial medical associations, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, will work with professional regulatory/licensing bodies to establish a harmonized policy environment that would support physicians who are providing telehealth care in multiple jurisdictions.
Last fall, the National Review of Medicine summarized the ongoing jurisdictional nightmare associated with providing telehealth services in Canada.
Drug cost concerns
The Canadian Medical Association recommends that physicians be provided with ready access to information regarding drug costs so these may be factored into decisions regarding patient care.
Pan-Canadian medical licence
The Canadian Medical Association and the provincial/territorial medical associations will work with certifying colleges and regulatory authorities to expedite the implementation of a system for national licensing of physicians and license portability between provinces and territories.
Unborn Victims of Crime Act
The Canadian Medical Association opposes the adoption of Bill C-484 and of any legislation that would result in compromising access for women to the medical services required to terminate a pregnancy.
A few days after this motion was passed, the federal minister of justice declared that his party would not support Bill C-484, the Unborn Victims of Crime Act, a private member’s bill proposed by a Conservative MP, which proposed an amendment to the Criminal Code to make the murder of a pregnant woman and her fetus count as two murders. Was the government’s decision to drop their support simply coincidental timing? The CMA certainly thinks not.
New HPV vaccine-anaphylaxis data creates a media muddle
Don't believe everything you read. Today's news provides a good example demonstrating the drastic shortcomings of much of the media when it comes to reporting on medical issues.
A team of Australian researchers wrote a study on the incidence of anaphylaxis caused by the human papillomavirus (HPV) vaccine, which appears in this week's Canadian Medical Association Journal. Their results showed:
From the 269 680 HPV vaccine doses administered in schools, 7 cases of anaphylaxis were identified, which represents an incidence rate of 2.6 per 100 000 doses (95% CI 1.0–5.3 per 100 000). [NB: There were zero cases of anaphylactic shock, and all seven girls recovered.] In comparison, the rate of identified anaphylaxis was 0.1 per 100 000 doses (95% CI 0.003–0.7) for conjugated meningococcal C vaccination in a 2003 school-based program.The incidence of anaphylaxis, they concluded, is significantly higher for the HPV vaccine than for other vaccines -- but not high enough to warrant skipping the vaccine. The anaphylaxis rate following the HPV vaccine is lower by an order of magnitude than the World Health Organization's definition of "very rare" vaccine adverse events, the study reports.
An accompanying CMAJ editorial calls the Australian study "compelling evidence that the HPV vaccine is remarkably safe" and urges girls not to delay their immunization. And a commentary by an American physician from the Institute for Vaccine Safety in the same issue of the journal says the study's findings "should not discourage the administration of this vaccine in school-based clinics" and even suggests that the current statistics from the United States indicate a much lower rate of anaphylaxis, perhaps as low as one in a million.
The data, combined with the support from senior scientists from the United States and Canada should reassure the public, right?
Wrong. Or at least that was what some major Canadian news sources thought.
I did a brief survey of the Canadian news reports on the CMAJ study. Here's what I found:
The Globe and MailWhat's important to note here is that it is crucial to know not just whether the article includes information, but also where it includes it and how. We journalists know that many readers won't read beyond the headline; they're reading on the bus, or as they pack for work, or skimming the headlines online. If readers do read beyond the headline, we're lucky if they make it to the second or third sentence.
Headline: "Risks of allergic reactions don't outweight benefits of HPV vaccine, study says"
Where the risks appear in the article: 1st sentence
Where the mention of the study's conclusion about safety appear in the article: 1st sentence
The Canadian Press
Headline: "Australians report higher-than-expected rate of allergic reaction to HPV shot"
Where the risks appear in the article: 1st sentence
Where the study's conclusion about safety appears in the article: 5th sentence
CBC News
Headline: "Severe side effects from HPV vaccine rare: study"
Where the risks appear in the article: 6th sentence
Where the study's conclusion about safety appears in the article: 1st sentence
CTV.ca News
Headline: "HPV vaccine shows higher rate of anaphylaxis: study"
Where the risks appear in the article: 1st sentence
Where the study's conclusion about safety appears in the article: 12th sentence
CanWest News Service (National Post, Montreal Gazette, Ottawa Citizen, Vancouver Sun, Calgary Herald, etc.)
Headline: "HPV vaccine 'remarkably safe' despite allergic reactions, new data shows"
Where the risks appear in the article: 1st sentence
Where the study's conclusion about safety appears in the article: 2nd sentence
That being said -- and believe me, reporters are aware of it -- the stories run by CTV News and the CP are both absolutely appalling. It's one thing to take an angle on a story or to interpret new information in context of past events, but it's quite another to present a study showing "safety" as showing "danger." (Their articles went on to describe the real results and conclusions of the study, but many readers won't read that far.)
What does it say about the state of health reporting that a major study that affects all Canadian families is so badly misinterpreted by two of the nation's biggest and best-trusted news outlets?
What's in the news: September 9
A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 9.
Fifteen proteins appear to confer HIV immunity, according to researchers from the Canadian National Microbiology Laboratory, the University of Manitoba and the University of Nairobi who have been studying Kenyan female sex workers who have avoided being infected with the virus. Their study was published last week in the Journal of Proteome Research. [University of Manitoba]
Gary Philion had a vasectomy. And then his wife, Kimberley, got pregnant. So they sued the urologist who performed the vasectomy. (His initial response was to ask Mr Philion, "How many extra-marital affairs has your wife had?") The couple was awarded $50,000 by an Ontario Superior Court judge at the end of August, The Globe and Mail reports today. [The Globe and Mail] [Read Justice Bryant's decision in full]
The 2003 SARS outbreak in Toronto, and its associated non-urgent hospital admissions restrictions, didn't negatively affect non-SARS patients. [Canadian Press]
McMaster physician and researcher Gordon Guyatt (NDP) kicks off his federal election campaign. [Gordon Guyatt's Blog]
Great story about the secret society of S3 deniers. (S3 is the third sound heard in the heart in congestive heart failure patients.) [Rheumination]
CanadianEMR's Dr Alan Brookstone worries about the implications of the new internet browser by Google, called Chrome, for physicians' EMRs -- especially given that many are now moving to web-based platforms [CanadianEMR]
McMaster researchers have conducted the first-ever study to determine how accurate self-reported BMI really is. Turns out, it's not very accurate at all. [Open Medicine]
Dr Arthur Porter, the director general and CEO of the McGill University Health Centre, was named to the Privy Council and the Security Intelligence Review Committee (SIRC) last Thursday. [McGill University] The Privy Council gives the government advice on legislation and policy; the SIRC oversees Canadian intelligence agencies. On the same day Dr Porter was appointed by the Prime Minister to serve on the five-member committee, the SIRC announced it is launching an investigation into the role of the Canadian Security Intelligence Service in the handling of the Omar Khadr case.
Dr Michelle Greiver published her diabetic audit, and explained how she did it. Pretty good results, I'd say. [Dr. Greiver's EMR]
The Medical Reform Group's fall members' meeting takes place next Wednesday evening, September 17, in Toronto. The pro-medicare lobby group's meeting, which will feature a talk by Ontario Ministry of Health assistant deputy minister Adalsteinn Brown, asks, "How can health providers address inequities in health and what can Medical Reform Group members and other activists do to advance the anti-poverty agenda through health?" MRG membership is $245/year for physicians, $60 for non-physicians and free for med students. More info about the meeting is available at 416-78705246 or by emailing medicalreform@sympatico.ca. [MRG]
In case you've been wondering what ever happened with the Charles Smith-inspired pediatric forensic pathology inquiry in Ontario: "The Hon. Stephen T. Goudge, Commissioner of the Inquiry into Pediatric Forensic Pathology in Ontario, plans to release his report to the public at 12 noon on Wednesday, October 1, 2008." High noon. [Goudge Inquiry] Retired Toronto Star reporter Harold Levy is counting down the days on his Charles Smith blog. [the charles smith blog]
British and American researchers are working on creating genetically modified pigs whose organs could be used to replace those of humans. [Canadian Press]
More sweat, less exercise-induced asthma. [HealthDay News]
From the new issue of Medical Hypotheses: Is balding caused by gravity? Does having more sex cause weight gain? Is the human body a "walking fermentator"? Does your birthday indicate your diabetes risk? Could H pylori treat multiple sclerosis? Does brain temperature control mood? Was the postmodern exam of President Kennedy incorrect? [Medical Hypotheses]
Monday, September 8, 2008
What's in the news: September 8
A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 8.
With yesterday's federal election call, there will be increased attention on Eric Hoskins, a physician, Rhodes scholar, Order of Canada recipient and president of War Child, a humanitarian organization dedicated to helping children in war zones. He's running for the Ontario seat of Haldimand-Norfolk, against Citizenship and Immigration Minister Diane Finley. Ms Finley won by a comfortable margin last election. [Eric Hoskins]
The Canadian Society for Vascular Surgery wants a national aortic aneurysm screening program. [The Globe and Mail]
Parti Québécois leader Pauline Marois had her appendix removed. Initial reports of her suffering from food poisoning (listeriosis, everyone wondered) turned out to be false. [Canadian Press]
Vancouver General Hospital is buying new pocket-sized ultrasound devices for its emergency/trauma radiology department. [Siemens Canada Ltd]
Mount Sinai Hospital researcher Dr Daniel Drucker is the lead author on a new paper appearing in The Lancet today on a once-per-week type 2 diabetes medication. [The Lancet abstract] [Mount Sinai press release]
Our favourite Canadian rheumatologist blogger, over at Rheumination, writes very cleverly about "Maximum allowable squeeze," or what is called "handshake titration." [Rheumination]
Cake? Or pork? Warning signs from Vancouver blogger Dr Martina Scholtens. [FreshMD]
The Canadian Centre for Policy Alternatives, a left-wing think tank, is hosting a conference in Vancouver from November 6-8 called "Re-Imagining Health Services: Innovations in Community Health Conference." [CCPA]
Alberta's Institute of Health Economics will hold a "consensus development conference" on depression in adults in Calgary from October 15-17, featuring Michael Kirby and Dr Scott Patten. [IHE]
The latest edition of Health Wonk Review, a health policy blog anthology, is available at InsureBlog. [InsureBlog]
The WSJ Health Blog on the WSJ Health Blog, and other big-name health and science blogs. [WSJ Health Blog]
Healthcare unlikely to emerge as major campaign issue as writ is dropped for Oct. 14 election
Prime Minister Stephen Harper's snap election call yesterday, which violates his pledge to institute fixed election dates, means that the campaign will last just five weeks. That means that, in such a short time, some subjects will inevitably be given short shrift in favour of this year's hot topics: the slip-sliding economy and Liberal leader Stéphane Dion's proposed "Green Shift" environmental tax reform.
Foremost among the issues that seem destined to be ignored is healthcare -- a disappointing outcome for not only the Canadian Medical Association but also the eternally cash-strapped provincial health ministries.
At a Quebec City meeting late last week, all the provincial health ministers as well as the federal health minister, Tony Clement, met to discuss current issues in the health sector. According to reports, the provincial ministers pushed Mr Clement to make healthcare reform a priority of his government, discussing food inspection, a national catastrophic drug coverage plan, electronic medical records, the shortage of healthcare personnel, and -- of course -- wait times.
Wait times, which have in most cases remained steady, remain a sore point for the Conservative government.
In one of the CMA's most partisan election messages in recent memory, President Dr Robert Ouellet referred somewhat obliquely to the Conservative minority government's struggle to fix the wait times problem. Today's CMA News reports:With Canadians preparing to go to the polls in a day-after-Thanksgiving federal election on Oct. 14, the CMA intends to remind candidates that the country has little to be thankful for when it comes to solving the shortage of health care personnel.
Despite the provincial ministers' pleas, and despite the CMA's criticism, however, it doesn't appear that health system reform will rank high in the list of issues the parties will present to voters over the coming weeks. A National Post online story on "Key Election Issues: Health care and public vs. private" managed only three paragraphs simply rehashing a few tired statistics and a handful of recent cookie-cutter pro-privatization quotes from Dr Ouellet. Not such a "key election issue" after all when there's hardly anything to say about the federal parties' positions on the matter, is there? But that's hardly the National Post's fault; because it's not clear who would benefit most from a prominent healthcare debate, the party's leaders have seemed hesitant to raise the issue.
"It puts things in perspective when you realize that the number of Canadians without a family doctor - five million - is almost as high as the number who voted for the Conservative Party in the 2006 election," President Robert Ouellet said after the writ was dropped Sept. 7.
"Our message will be that, yes, we acknowledge that Canada is facing many serious problems, but we are not going to allow health care to be shoved to the sidelines because of them. These issues, from wait times to personnel shortages, are too important." [...]
But there is one aspect of healthcare that will play a major role in the election campaign in the coming weeks: the ongoing tainted-deli-meat-and-cheese listeriosis outbreak.
Mr Harper's office has tried to fend off attacks on the issue by launching an investigation into the spread of the disease that has left more than a dozen Canadians dead. The government's position was, for a time, that the nation's food-inspection system was working perfectly -- just look at how we've identified the listeriosis cases! -- but the obvious rejoinder quickly trumped that argument and now seems to have made the listeriosis outbreak a central campaign issue for Mr Dion.
It remains possible that the listeriosis issue could lead to a frank and full discussion of the party's positions on healthcare reform, but given the constraints of a five-week campaign that seems doubtful.
ENDORSEMENTS AND PARTISANSHIP
Here's a question: Are Dr Ouellet's vague comments the best the CMA can muster to get healthcare on the front page? There have been some -- myself among them -- who have suggested that the CMA could do more to promote discourse on healthcare during federal elections.
At a recent press conference, I asked CMA past-president Dr Brian Day whether the organization might consider -- as a method of drawing extra attention to healthcare reform -- revisiting the CMA's policy of not endorsing a political party.SAM SOLOMON: Dr Day, you were talking a moment ago about raising awareness in Ottawa and lobbying the parties. Do you not think it might be more effective to actually endorse? I know you spoke a moment ago about the importance of being impartial and being nonpartisan, but why doesn't the Canadian Medical Association consider endorsing a party for an election? You yourself have said to me before that doctors have a very influential position.
The Alberta Medical Association's approach was an interesting one, although the party that was ranked highest on healthcare issues by Alberta doctors ended up with a disastrous defeat in the polls. The AMA poll did manage, nevertheless, to attract a fairly large amount of media attention in the run-up to the election there in March. A similar strategy doesn't appear to be on the CMA's to-do list, and given that there are just five weeks until Canadians vote, there likely isn't time to change that.
BRIAN DAY: I don't think it's up to us. We are elected as representatives of doctors, not to tell them or advise them on how to vote. I think what we would do as an association is if any party came out with policies that embraced the points we have been making, we would endorse those policies, not necessarily the party itself.
SAM SOLOMON: Might you consider doing similar to what the Alberta Medical Association did during the last provincial election there, where the held a poll and released the results, asking who had the best healthcare platform. I believe the Liberals came out on top there, in Alberta.
BRIAN DAY: Possibly. I think that, again, the difficulty I have -- and I sat through the Throne Speech, for example -- that is why I think it is nonpartisan. I think the two biggest federal parties seem reluctant to talk about healthcare issues... To me for the Conservatives not to mention healthcare in a 30-minute Throne Speech, and then for the Liberals to put a questionnaire with multiple questions and not one is on healthcare? To me we should give them a wake-up call. And they will get a wake-up call from the CMA if there is an election and if one party chooses to embrace issues on improving the healthcare system and they agree with our policies, we will endorse those principles. That doesn't mean we will say "Vote for this party, vote for that party" but we will endorse the principles that party is promoting for sure.
Psychiatrists vow to fight stigma: "We need to clean up our own backyard"
After an emotional call at last month's Canadian Medical Association conference to reduce the stigmatization by physicians of mental-health patients, the Canadian Psychiatric Association announced Friday it would lead the charge to eliminate discrimination within its own ranks and among other health professionals.
"We need to clean up our own backyard before we can move on to the neighbours," Dr Manon Charbonneau, the CPA's past-president and chair of the new Stigma Working Group, said in a release. "We are in a unique position to advocate for real change and provide leadership to our medical colleagues."
The announcement comes just weeks after the renowned Canadian geographer and NASA scientist Austin Mardon, PhD (right), spoke out publicly about the problem of discrimination and unfair treatment within Canada's mental-health treatment system.
Dr Mardon, a top-notch researcher and historical writer whose work recovering stray bits of meteorites in Antarctica has won him a bevy of international acclaim and awards, told the doctors assembled at the CMA conference about his experience being diagnosed with schizophrenia and how the way he was treated by his doctors failed to conform to ethical standards.
The same day, Mental Health Commission of Canada chair Michael Kirby addressed some of the same issues. A CMA summary of the event reported:Kirby then pointed out that people living with mental illness say that the accompanying stigma and discrimination "are often worse than the disease itself," and one of the commission's main goals will be to fight that discrimination with a campaign that will last at least a decade. "We intend to educate people, and one of our first targets is the health care profession."
The CMA also passed a number of important resolutions that day, which are responsible in part for the impressive recent Canadian Psychiatric Association announcement. The pertinent resolutions were:
He argued that prejudice against mental illness is alive and well within medicine and challenged "each of you in this room, because physicians are leaders in the community and you can play an absolutely invaluable role by becoming community leaders on [this] issue."The Canadian Medical Association urges Canadian physicians and their organizations to work together to transform patient care for people with mental illnesses through a strategy, including but not limited to:
Photo: Austen Mardon
-fighting the stigma that exists in our own profession and physician organizations;
advocating for parity of allocation of resources toward the continuum of mental health care and research;
-promoting an evidence-based mental health system anchored on: strong primary care networks, community-based care, team-based and multidisciplinary care in a public system, adequate social policy supports such as housing and income, and the involvement of primary care and specialist physicians in the planning processes. (SS1 7-17)
The Canadian Medical Association will develop a five-year plan focused on improving access to mental health prevention and treatment and eliminating stigma and discrimination. (SS1 7-2)
The Canadian Medical Association will work with the Canadian Psychiatric Association and the Mental Health Commission of Canada to develop and implement stigma-reduction-programs that target stigmatization generated within the health care system. (SS1 7-18)
The Canadian Medical Association will encourage medical schools to address, in undergraduate and postgraduate curricula, the impact of stigma in the diagnosis and treatment of and recovery from mental illness regardless of age, gender, ethnicity or religion. (SS1 7-19)
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders. (SS1 7-12)
