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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]

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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.

  • From the Associated Press we get an update on the World Trade Center Health Registry, which so far reveals up to 70,000 people suffer from post-traumatic stress disorder, and up to 12,600 from asthma, as a result of the New York attacks. [Associated Press]
  • The Sydney (Australia) Morning Herald writes about an experimental virtual reality trauma re-exposure treatment centre at Cornell University. [Sydney Morning Herald]
  • Three US congressmen are criticizing the federal Department of Health and Human Services for "continued foot-dragging" on moving ahead with a new health plan for rescue workers with 9/11-related medical problems. [New York Sun]
  • Meanwhile, however, The New Yorker has a new article by Jennifer Kahn, "A Cloud of Smoke," that reveals the vehement behind-the-scenes clinical disagreements that have plagued the effort to create a compensation plan for New York residents and workers injured as a result of the attacks. [The New Yorker] The Associated Press wonders whether Ms Kahn's article will set back progress on establishing the compensation plan. [Associated Press]
  • Many rescue workers and Lower Manhattan residents have still not been treated for physical and mental health problems caused by the attacks, reports the WTC Medical Working Group, a research body overseen by the city government under Mayor Michael Bloomberg. [Environment News Service]
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]

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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.)

  • Adventures in Medicine - Two Iqualuit MDs



  • Anatomy on the Beach



  • Canadian Association of Medical Teams Abroad



  • Canadian Doctors for Medicare - Drs Danielle Martin and Richard Pickering



  • CBC.ca Weekly Checkup - Dr Bretty Taylor, and more



  • Direct from the Field! - Canadian Physicians for Aid and Relief-Tanzania



  • CanadianEMR - Dr Alan Brookstone



  • CMAJ Blog



  • Clinical Depression in Canada - Dr Scott Patten



  • Consciously Sedated - Dr Alika Lafontaine



  • Dr Sharma's Obesity Notes - Dr Arya Sharma



  • Dr Carolyn Bennett, Liberal MP



  • Dr David Swann, Alberta MLA



  • Dr Greiver's EMR - Dr Michelle Greiver



  • Dr Roy's Thoughts - Dr Roy Eappen



  • Fabulous, STAT! - Dr Norm Furtado



  • Farchana Nights - Dr Steven Cohen



  • Fibromyalgia and Exercise



  • FreshMD - Dr Martina Scholtens



  • Gordon Guyatt's Blog - Dr Gordon Guyatt



  • Haiti Village Health - Dr Tiffany Keenan and others



  • Hedz Sez - Dr Hedy Fry, Liberal MP



  • Hors des lieux communs (Ptaff.ca) - Dr Miguel Tremblay



  • Incidental Findings - Dr Alison Sinclair



  • Info-Santé



  • Inuvik Weblog - Dr Abraham de Klerk


  • Jon Gerrard's Blog - Dr Jon Gerrard



  • Kelly Christine (med student)



  • Lewis Mehl-Madrona



  • Med Valley High - Dr Liana



  • Medical Education Blog - University of Saskatchewan College of Medicine



  • Medical Jokes - Dr Antonio Rambaldi



  • Medical Palm Review - Dr Paul Arnold



  • Musings on transfusion medicine - Dr Pat Letendre



  • Off the beaten path in PNG - Dr Nazanin Meshkat (MSF)



  • On the Other Side of the Mountain (formerly A Resident's Life) - Dr McBain



  • Plain Brown Wrapper - Dr Kishore Visvanathan



  • Québec solidaire-Mercier - Dr Amir Khadir



  • Rheumination



  • Saskatchewan FMU Faculty Development Blog - Dr Jason Hosain



  • Susan in Lesotho - Dr Susan Ackland



  • Taking Steps - Dr Edward Leyton



  • Tales from the Emergency Room and Beyond - Dr Couz



  • The Breast Reloaded



  • The Healthy CEO - Dr Larry Ohlhauser



  • The Physician Executive



  • The Prostate Reloaded



  • Therapeutics Initiative (UBC) podcast



  • Tommy C Douglas was LEFT - HammertimeGP



  • Vitum Medicinus



  • Wait Time & Delayed Care - Ian Furst



  • Weighty Matters - Dr Yoni Freedhoff



  • What's Wrong with Healthcare?



  • White Coat, Black Art (CBC Radio) - Dr Brian Goldman



  • Zimbits - Dr Danielle Harssema


  • Read more...

    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]

    Read more...

    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.

    “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?”
    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.

    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.

    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.
    Just like that, Dr Lindeman became the poster boy for the legal dangers to doctors of blogging.

    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.

    “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.”
    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.

    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

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    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.


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    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 Mail
    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
    What'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.

    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?

    Read more...

    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]

    Read more...

    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]

    Read more...

    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.

    "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." [...]
    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.

    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.

    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.
    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.

    Read more...

    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."

    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 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:
    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:
    -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)

    Photo: Austen Mardon

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