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Friday, November 14, 2008

New study adds weight to call for boys to get HPV vaccine too

Should boys be vaccinated against human papillomavirus (HPV) alongside the girls?

That’s what Harald zur Hausen (right), the German scientist who was awarded the 2008 Nobel Prize for medicine and a 2008 Gairdner award for discovering the virus's link to cervical cancer, said on a speaking tour of Ontario universities last month. “It’s really important also to vaccinate young men,” he said in a University of Western Ontario release. “Clearly you should protect your partner to not put your partner at risk... Why not have better effects by having more persons vaccinated?”

Besides the potential benefit of reducing the transmission risk, Dr zur Hausen said, protecting boys from HPV infection could also protect them from contracting related cancers. Last year, in a review article in the journal Cancer, a team of researchers from Houston, Texas, came out strongly in favour of vaccinating boys for that very reason. “[W]e fear that vaccination programs limited to females will only delay the potential benefit in prevention of HPV-16/18-associated oropharyngeal cancers, which typically occur in men,” they wrote. “We encourage the rapid study of the efficacy and safety of these vaccines in males and, if successful, the recommendation of vaccination in young adult and adolescent males.”

Well, the first study on the HPV vaccine for boys has finally arrived, although some experts are likely to find it disappointing.

Yesterday, Merck released interim results of a clinical trial that is testing the vaccine on 4,000 HPV-free men between the ages of 16 to 26. (Merck is the manufacturer of Gardasil, the only HPV vaccine cleared for use in Canada, approved only for girls. Another vaccine, Cervarix, made by GlaxoSmithKline, is under review for approval by Health Canada.) Though the trial’s results haven’t been published in a peer-reviewed journal yet -- they were presented yesterday at a conference of the European Research Organization on Genital Infection and Neoplasia, in Nice, France -- the data at a three-year follow-up are encouraging in terms of the vaccine’s effectiveness at preventing genital lesions and genital warts. Only three of the 2,000 patients who received the vaccine got genital warts, compared to 31 in the control group. The vaccine also decreased the viral load in patients already infected with HPV by up to seven times more than the control.

“The study is still ongoing, but we're relieved to know that it is as effective in men as it is in women,” Dr François Coutlée, a University of Montreal microbiologist who recruited patients in Montreal for the Merck-funded trial, told Canwest News Service.

However, the study failed to show any effect on cancer rates in boys. None of the trial participants were diagnosed with penile, perineal or perianal cancers by the end of the study. Three patients in the control group were diagnosed with potentially precancerous lesions, compared to zero in the vaccinated group, but those numbers are too small to be meaningful. (It’s not clear why Merck didn’t include oropharyngeal cancers in its study, as the Texas team had hoped.) The study’s failure to demonstrate the vaccine’s effect on cancer is a function of the same problem that some critics of the HPV vaccine identified in the trials on girls: the trials’ follow-up periods aren’t long enough to determine whether there will actually be a drop in cancers, and, if so, how long the vaccine’s protection will last.

“Men can unknowingly transmit HPV to their partners, putting them at risk for developing HPV related disease - most notably, cervical cancer in women. HPV can also cause penile and anal cancer in men, as well as genital warts,” Merck spokesperson Tracy Ogden told Canadian Medicine. “Merck is pursuing an indication in males aged 9-26 and plans to submit a regulatory application to the Food and Drug Administration later this year.”

Photo: Nobelprize.org

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What's in the news: Nov. 14 -- Fast food hospitals

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, November 14.

In 2006, the Colonel Harland Sanders Charitable Organization donated one million dollars to the McMaster Children's Hospital in Hamilton, Ontario. "Naturally enough," wrote The Globe and Mail's André Picard yesterday, "it has been nicknamed the chicken wing." In a particularly hard-hitting, Bob Dylan-quoting article, Mr Picard's question is: "When and why did it become acceptable for public institutions to prostitute themselves in this manner?" The column's tone is sure to stir up some emotional responses from hospital administrators from St John's to Victoria. [The Globe and Mail]

The number of reports in Ontario of DayQuil pills hidden in sealed boxes of Smarties given out during Halloween is now up to eight, with seven in Pickering and one in Burlington. [Toronto Star]

Five Saskatchewan towns have now been revealed to have been reusing syringes to inject drugs into multiple patients' IV lines. [CBC News]

The facilities for the University of Western Ontario's satellite medical campus in Windsor are finally done, and they're so spiffy that the faculty at the main campus, in London, are getting jealous. Among the new developments is videoconferencing technology to link Windsor classrooms to the London campus. "If you see the facilities here, you will see that we are almost spoiled, a fact that has not been lost on our London-based brethren," said a student quoted in the school's release. "It’s actually surprising how envy can be transmitted through videoconferencing." [UWO]

A test developed by Memorial University genetics researchers to detect arrhythmogenic right ventricular cardiomyopathy, a potentially lethal cardiac condition, will be made available worldwide via a Boston company called PGxHealth Ltd. The test will be available outside Canada by the end of the year. [Memorial University]

QUEBEC ELECTION UPDATE: The biggest healthcare issue that's emerged so far during the campaign is one that you'll have to look back to the 1990s to find its origin. Discussing the shortage of nurses in the public system, Liberal Premier Jean Charest has placed all the blame for the shortfall on Parti Québécois leader Pauline Marois. During the time Ms Marois was the province's health minister from 1998 to 2001, thousands of nurses and over a thousand physicians were offered lucrative early-retirement deals, as a cost-cutting measure by the government. The Liberals have a "colossal job to do to repair the damage done by Marois," said Mr Charest. [Montreal Gazette][Canadian Press] The PQ's boldest promise so far has been a pledge to repeals the private-clinic portions of Bill 33, the law passed in response to the Supreme Court of Canada's 2005 decision in Chaoulli v Quebec. [Parti Québécois health platform (French only, bien sûr)] The PQ's main avenue of attack appears to be the Liberals' failure to address the wait times problem, which was one of the party's promises when it defeated the PQ in 2003. [Parti Québécois]

The global shortage of affordable antivenom is a market failure, according to a very interesting new article. The world needs to agree on new standards in epidemiological research on snakebites and associated injuries and deaths, in order to give the antivenom market sufficient data to fix the market, said researcher Jean-Philippe Chippaux. [PLoS Medicine]

Today is the launch of Shiv Chopra's new book, Corrupt to the Core: Memoirs of a Health Canada Whistleblower, about his battles with senior governments officials over drug approvals and food safety. [news release]

Dr James Orbinski, the humanitarian physician and former international president of Doctors Without Borders, has been named to the "longlist" of 15 authors under consideration for the BC National Award for Canadian Non-Fiction. Dr Orbinski was nominated for his new book, An Imperfect Offering. He is in prestigious company, with John Ralston Saul, Susan Pinker and others. [news release] Did you miss our recent interview of Dr Orbinski? He told us about his book, a new documentary about his work, and what he's doing now. [Canadian Medicine]

Vancouver Sun columnist Douglas Todd wrote yesterday about Dr Maureen Mayhew, a physician who has worked with Doctors Without Borders in Afghanistan. She wrote a chapter in the book Outside the Wire, which was edited by another Canadian physician, Kevin Patterson. [Vancouver Sun]

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Thursday, November 13, 2008

What's in the news: Nov. 13 -- Evidence-based prevention, primary care in focus, text messaging

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, November 13.

Certain physicians are more likely to provide evidence-based preventive care than others. Which ones are doing it right? Women, doctors who teach, graduates of Canadian med schools, and doctors who are not in solo practice, according to a new University of Western Ontario study in the journal Canadian Family Physician. [Canadian Family Physician]

Among eight industrialized countries, Canada has the longest wait times for patients with chronic illnesses to see a specialist. And only the US had a similarly low proportion as Canada of patients who could get same-day care, at 26%. That's according to a new survey from the Commonwealth Fund, published online today in Health Affairs. [Canadian Press] [Health Affairs]

Doctors-in-training are increasingly having trouble getting the residencies they request, said the Canadian Federation of Medical Students. "As more and more students graduate from Canadian schools, a corresponding increase in residency positions is needed to ensure match success and to allow for retraining." Thirteen percent of students didn't receive any of their top three choices for residency spots this year. There was one bright spot in the news: 31% listed family medicine residencies as their top pick, "the highest result in almost a decade," reported the Canadian Medical Association. [CMA News]

The New England Journal of Medicine has a special section on "redesigning primary care" in today's issue. [NEJM]

The College of Family Physicians of Canada announced the 10 recipients of the Reg L Perkins Award, for the family physicians of the year. They are:

Susan Harris, Vancouver, BC
Mark Sosnowski, Calgary, AB
Brenda Hookenson, Prince Albert, SK
Michael Penrose, Dauphin, MB
Frank A. Martino, Brampton, ON
Jean Grégoire, St-Simon-les-mines, QC
Thomas Laughlin, Moncton, NB
Susan Atkinson, Halifax, NS
Douglas H. Meek, Charlottetown, PE
Judy Ophel, Goose Bay, NL
One of them, Dr Laughlin, was profiled in his local newspaper today. "To be singled out by your peers is something special. I guess I was in the right place at the right time," he said. [Moncton Times & Transcript] [CFPC]

QUEBEC ELECTION UPDATE: The Quebec hospital association issued a demand to all the political parties to answer several important questions about their plans for healthcare. The group wants to know how the parties would meet the financing challenges the healthcare system is facing, how much of the budget they intend to spend on health and social services, how they would deal with the health human resources shortage, and how they would reduce wait times. "They must provide citizens with answers. The economic crisis is major but it should not be used to downplay the need for health services," said Lise Denis, the association's president. [Montreal Gazette] [news release]

A Nova Scotian initiative to rent operating room time at a private clinic in order to perform publicly insured surgeries has been a success and should be extended, a provincial health official said. [Halifax Chronicle-Herald]

The latest edition of Health Wonk Review, an anthology of the best recent health-policy blog posts, is now available. [Colorado Health Insurance Insider] Recommended reads include the entry from Home of the Brave on poverty, health and politics in Appalachia. Health Beat Blog investigated the problem of eternally rising health spending that doesn't seem to be correlated with better outcomes (this is a problem in Canada, too) and identified inefficient use of medical technology as the primary driver of health costs inflation. Healthcare Economist covered the same topic, as did Disease Management Care Blog.

Can text messaging help kids eat better and exercise more? A new study suggested just that, but Dr Arya Sharma isn't so sure. He called the texting strategy "little more than a gimmick, with minimal long-term impact, if at all." [Dr Sharma's Obesity Notes]

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Wednesday, November 12, 2008

Doctor sex scandals: Should they be made public?

It's an ongoing debate in the medical profession: is full disclosure of doctors' sexual dalliances by medical regulatory bodies a good idea?

On one hand, transparency and openness are all the rage now in models of good governance these days. Probably most people wouldn't argue that transparency is a good policy in most situations. But some matters -- like, say, doctors' sex scandals -- might not be good candidates for such openness, some physicians are thinking now.

Several embarrassing cases over the past year or two, in which physicians became sexually involved with their patients or even their patients' mothers, have some doctors wondering whether airing the medical profession's dirty laundry is really so prudent.

DR GERALD PAUL DEMPSEY
Last year, the College of Physicians and Surgeons of Ontario (CPSO) held a hearing on alleged misconduct by Dr Dempsey, a pediatrician. Their finding (PDF) was that "sexual liaisons with the mothers of two of his pediatric patients had the potential to cloud his judgment and compromise his care of the children."

A response (PDF) to the announcement of Dr Dempsey's case, from Dr Robert Wagman, a Toronto physician, was published this April:

I am not convinced that Dr. Dempsey’s conduct necessarily “would reasonably be regarded by members as disgraceful, dishonorable or unprofessional.” Given total agreement with the zero-tolerance policy regarding sexual relationships with patients, I wonder if Dr. Dempsey’s conduct was just plainly stupid...

In the grand scheme of things in the world in general and in the medical community in Ontario in particular, unless there is more to this story than is being reported, I would suggest that it would have been more appropriate for the College to have published this case with the doctor’s name withheld. That way he would have been spared the public humiliation while the membership would still have been made aware of the issue and of the College’s policy on the matter.
The CPSO answered that in Dr Dempsey's case, because he was guilty (he admitted his guilt), the College was obligated by law to report his name.

DR CURTIS BELL
Last November, the College of Physicians and Surgeons of Alberta found Dr Curtis Bell guilty of "unbecoming conduct," including:
i) soliciting his patient to become involved in a sexual relationship with him;
ii) kissing and sexually fondling his patient on more than one occasion, including on June 6, 2006 during an appointment to see his patient’s daughter;
iii) discussing his sexual preferences with his patient;
iv) exposing himself to his patient;
v) suggesting sexual acts to his patient;
vi) conducting lengthy telephone conversations with his patient;
vii) sending numerous text messages to his patient that included discussions of his interest in having a sexual relationship with a patient.
Part of his punishment -- which consisted of a suspension held in abeyance, a $15,000 fee for hearing expenses, and mandatory training and boundary-violation lessons -- was the publication of his case in the College's newsletter (PDF). (As was true in Dr Dempsey's case as well, all the interactions Dr Bell had with his patient were consensual.)

In the August 2008 issue of that newsletter (PDF), called The Messenger, Dr Muriel Solomon wrote in to complain:
"[W]ho among us can fling the first stone? Sure, our colleagues made mistakes and are paying the price but this could have happened to any one of us. I think to myself “there, but for the grace of God, go I.”

"I take strong exception to the publication of names of our fallen colleagues. They know who they are. They are probably suffering for their misdemeanors. Need we rub it in?

"I was about to throw The Messenger into the recycling bin when I was stopped by the thought that this publication could very easily be read by anyone in the public. Transparency is good - it is the modern catchword - but must we hang out our dirty laundry for all to see? Where is our solidarity and empathy for one of our own who has fallen? After all, we are but human..."
Dr Karen Mazurek, the College's associate registrar of complaints, responded, "Medicine is a self-regulating profession, a privilege granted by the public. With this privilege comes certain responsibilities, including the need to be accountable to both the public and the profession." And that's not all. Dr Mazurek added that when the Alberta College is moved under the jurisdiction of the Health Professions Act -- a change which still has not come about yet -- all complaints will have to be made public by law, as opposed to only disclosing most of the guilty findings, as is the case in Alberta right now.

DISCLOSURE ETHICS
This September, another letter arrived in the mailbox of the CPSO. Dr John Sauret, a physician who left Ontario to practise in New York, wrote (PDF):
The CPSO seems to enjoy parading their disciplinary actions against physicians.

I don’t suppose there could be imposed any disciplinary action against the CPSO for the absolute debacle of health care in Ontario over the last two decades?

I am a licensed family physician in Ontario, and based on your actions and history I do not plan on returning anytime soon.
Is full disclosure alienating physicians from their regulators? Is it possible that what appears to be something of a backlash in several recent incidents might contribute to physicians' reluctance to report cases of colleagues' misconduct, because they believe the punishment is too harsh? These are important questions and, judging by the complaints above, there's growing frustration in the medical profession that those questions aren't being asked.

What do you think? Is airing the medical profession's filthy laundry -- undergarments and all -- appropriate, or does it cross the line?

Photo: Shutterstock (Yes, I recognize how outrageous that photo is. It's just a goofy, staged stock photo, of course.)

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What's in the news: Nov. 12 -- Healthcare in the Quebec election, epigenetics, children's health

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, November 12.

As the Quebec election campaign forges ahead, the province's healthcare system is lagging behind. Pharmacists, in an ongoing dispute over salaries, have suspended their teaching in protest of the government's reluctance to act. [Montreal Gazette] Nurses will continue to be forced to do mandatory overtime shifts regardless of union complaints, Health Minister Yves Bolduc said. [Montreal Gazette] The government's attitude came under harsh criticism in a Gazette editorial. [Montreal Gazette] Nurses affiliated with the University of Montreal have refused to do overtime work unless their pay is doubled for those shifts. Their demands haven't been met and the hospital has had to close 50 beds. [CBC News] The Parti Québécois warned that reelecting the incumbent Liberals would lead to further privatization of the healthcare system, and therefore fewer doctors available for patients under the public insurance plan. "The government has created the conditions for the emergence of a private industry in the health-care sector, and we are very concerned that if Charest is re-elected, he's going to go even farther," said PQ health critic Bernard Drainville. [Montreal Gazette] A new poll identified "Accessibility/quality of health care" as the top concern of Quebec voters.

The New York Times yesterday took a long and fascinating look at new research being conducted by Simon Fraser University biologist Bernard Crespi on the genetic origins of mental illness. His controversial theory is that an epigenetic battle is waged during brain development. If the brain is pulled towards the genes donated by the father's sperm, then the child will be pulled towards the autism spectrum. If the brain is pulled towards the genes donated by the mother's egg, the child will instead end up on the "psychotic spectrum," with schizophrenia, depression and bipolar disorder more common. His idea, researched in collaboration with Christopher Badcock, amounts to a sort of unified theory of mental illness. "The reality, and I think both of the authors would agree, is that many of the details of their theory are going to be wrong; and it is, at this point, just a theory. But the idea is plausible. And it gives researchers a great opportunity for hypothesis generation, which I think can shake up the field in good ways," one neuroscientist commented to the Times. [New York Times]

A government-sponsored environmental safety monitoring program is on its way in northern Alberta, announced provincial Environment Minister Rob Renner. [CBC News] The announcement comes in the wake of complaints from local First Nations and advocacy groups about food and water supplies that may be contaminated by run-off from the oil-sand developments. Reports of increase rates of unusual cancers have emerged and been disputed. The methodology of the research on both sides of the issue has been called into question.

A woman kicked out of a Newmarket, Ontario, swimming centre for breastfeeding in the pool is fighting back. But so is the pool's owner -- also pregnant, coincidentally -- who hired a team of four bullet-proof-vest-clad security guards to prevent a group of protesters ("lactivists") from breastfeeding in the pool. "[The water is] filled with stuff that you can't kill – people's pee and sweat and body stuff is in there," said the pool's owner. "Am I ever going to stick my baby's mouth on a breast that's been in a pool without cleaning it? Never, ever." [Toronto Star]

Talk of making health insurance mandatory is back in the US, despite Barack Obama's decision not to endorse the concept during the election campaign. Max Baucus, a Democratic senator and chair of the Senate's Finance Committee, has proposed a plan similar to what Mr Obama had spoken of, but with a mandate as well. The mandate could be enforced by the threat of tax penalties, Mr Baucus said. [Wall Street Journal] According to the Washington Post, Senator Ted Kennedy plans to have legislation ready to go by the time of Mr Obama's inauguration in January. [Washington Post] This is by no means the end of the argument, however. Mr Baucus's plan is preliminary, and it remains to be seen whether Mr Obama may prefer to encourage Congress to move more gradually on health insurance reform.

Canadian healthcare analyst Steven Lewis published an essay on what should be included in "full monty media coverage" of Canada's healthcare system, "practices that without question harm more people than reused syringes, inconvenience the public and patients, drive up costs or create gaps in the system." His list mentions handwritten prescriptions, the lack of uptake of electronic records, single-complaint doctors visits, and misguided credentialing requirements. "Canadians should worry more about the general standard of practice than about the prospect of falling victim to brazen or malicious incompetence," he wrote. [Longwoods Essays blog]

A British Columbia judge decided to allow a lawsuit to go ahead against Microsoft, Telus, Wal-Mart, the RCMP, the College of Physicians and Surgeons of British Columbia and the University of British Columbia. Jerry Rose alleges "that he has been subject to invasive brain computer interface technology, research, experiments, field studies and surgery" and that he has been targeted by satantic rituals and witchcraft. He is asking for the modest sum of $2 billion in damages. [Nanaimo Daily News]

There remains a great deal of disparity in health outcomes between Manitoban children from wealthy families and Manitoban children from poor families, a new study showed. “We would like to assume that every child born in Manitoba is given a fair and equal chance at being healthy” researcher Dr Marni Brownell said in a release. “Unfortunately, time and time again, this assumption has been proven wrong." [University of Manitoba]

McMaster University's chair of pediatrics, Dr Peter Steer, has resigned and will head back to Australia, where he was born, to run a new children's hospital in Brisbane. His departure is a significant loss for the Hamilton pediatrics community. [McMaster]

The city of Manchester, England has introduced a strange new health promotion project: a rewards card for residents that can be used when buying healthy food or using the gym. The rewards include athletic equipment, personal training and donations to school athletics. [Canadian Press]

A new study has sparked a debate about the merit of screening patients with heart conditions for depression. One group approved of screening in September, but a new review by Canadian and international researchers in the Journal of the American Medical Association said it's of no use. [Canadian Press] [JAMA abstract]

A newfangled drug delivery system -- called "iPill," of course -- uses wireless communications and an onboard computer to get drugs to the right place in the digestive tract at the right time. That's really something. [Reuters]

More cool medical technology news: Google has come up with a way to track influenza prevalence by analyzing search engine trends. [New York Times]

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Tuesday, November 11, 2008

What's in the news: Nov. 11 -- Remembrance Day

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, November 11.

Today marks the eighth consecutive year that Canada has been at war on Remembrance Day. From a health perspective -- besides the mortality and morbidity in Afghanistan -- recent estimates have placed the prevalence of post-traumatic stress disorder among Canadian vets at one in 10. Veterans are also at high risk for depression, addiction and suicide.

Large numbers of high-tech medical equipment used in Canadian hospitals is dangerously out of date, a new Fraser Institute report found. The numbers are rather frightening: for instance, 46% of hospital angiography suites were beyond their life expectancy as of last year. Of course, the Fraser Institute's solution is predictable: "This is a failure of the Canadian health care model... It's time to consider alternatives to the status quo if we want to achieve a world-class, universal access health care system," said Nadeem Esmail in a release. "Unless we allow more competition into the both the financing and delivery of health care services, Canadians will continue to be burdened with lengthy waiting lists and outdated medical equipment." [news release] [full report (PDF)] [Calgary Sun]

Dr Henry Morgentaler's lawsuit against the government of New Brunswick doesn't appear to be moving ahead very quickly. The Daily Gleaner reported last week that the government is appealing a judge's decision in August that Dr Morgentaler is indeed permitted to bring suit against New Brunswick in light of his advocacy in the public interest. [Fredericton Daily Gleaner] Dr Morgentaler's lawsuit alleges that the provincial government is acting illegally by refusing to publicly insure abortion procedures performed at the Morgentaler clinic in Fredericton. The Morgentaler clinic there allows women to get access to abortion without any roadblocks. New Brunswick has the most restrictive policies in the country on access to publicly funded abortion services, requiring two doctors to approve a woman's request. Every other province in Canada funds abortions done at private clinics. (Quebec lost a class-action lawsuit in 2006 and had to reimburse women for costs incurred at private clinics.)

A forthcoming study by the Alberta Cancer Board has been rejected by the First Nations groups around Fort Chipewyan -- before the study has even been released. The First Nations groups in that region, which have been the subjects of reports on high rates of unusual cancers, said they weren't consulted for the report. [Edmonton Journal] Two weeks ago, Dr John O'Connor, the physician responsible for warning the Fort Chip First Nations about the elevated cancer rates, explained to me his apprehension about the new study: "They seem to not doing anything new -- just repackaging the 2006 one, which was incomplete. We were expecting a level 2 [retrospective] study, but it is not," he said. "But we have not seen it yet," he hastened to add.

Remember those comedy skits you put together with your classmates back in med school? With the boys in drag and jokes about incompetent doctors and dead patients? Well, the new crop of medical students -- of the YouTube generation -- are putting videos of their sketches online for anyone to see. Some worry about what kind of image that projects about medical schools and physicians, but on the other hand some of the videos are hilarious. [Slate]

Canadian Medical Association President Dr Robert Ouellet is going to Europe to take a closer look at some of the health systems. If he went with an open mind, write Dr Danielle Martin and Robert Huish in The Tyee, he would discover that most of the top European systems rely even more on government funding than the Canadian system does, and they're better organized to provide primary care efficiently. But they are not hopeful Dr Ouellet and his travel companions will get the message. "Are these the lessons the CMA is setting out to learn? Or are our medical leaders simply looking for another way to promote more commercialization in health care, by twisting the ways in which private insurance and corporate for-profit delivery would meet their own agendas?" [The Tyee]

Dr Stanley Muwanguzi has won his fight against the Canadian immigration system. The South African-born critical care physician in Calgary earlier had his immigration application denied because his daughter, who suffers from cerebral palsy and lives in South Africa, might have become a burden on the Canadian healthcare system. But his appeal has been approved "on humanitarian grounds," reported CBC News. [CBC News] The lesson to other doctors in similar immigration muddles seems to be that going to the press will result in a swift and positive decision from the government.

McGill took the top spot once again in Maclean's overall ranking of Canadian medical/doctoral universities, followed by the University of Toronto and Queen's. [Maclean's] A different ranking system, focusing on medical programs and undoubtedly using a different methodology, last week named the University of Toronto the number-one med school, with McGill coming in second. [Canadian Medicine]

This week's medical blog Grand Rounds is online, hosted by Dr Rob in a very amusing format. [Musings of a Distractible Mind] Some highlights: HealthBlawg interviewed Institute for Healthcare Improvement CEO Don Berwick. The Sterile Eye visited Glasgow's Hunterian Museum to see an exhibition on medicine; the article includes some great photos. Health Business Blog argued that the current economic conditions in the US make a government-run single-payer health insurance plan a distinct possibility in the very near future. Dr Deb reported on a study to be published in January that identified a genetic basis for gender identity disorder.

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Monday, November 10, 2008

What's in the news: Nov. 10 -- JUPITER, iPod, Hall of Fame

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, November 10.

New federal Health Minister Leona Aglukkaq "did not improve anything in Nunavut" as territorial health minister, a senior Nunavut nurse said. The main complaint: Ms Aglukkaq failed to address the severe staffing shortages that plague the territory. "I would have given her a different portfolio. I don't think she proved herself as a minister of health. It was a very negative experience," said former nurses' union head Cheryl Young. [Nunatsiaq News]

Taking statins appears to be beneficial even to people whose cholesterol is not elevated, an important new study found. The study, nicknamed JUPITER and presented yesterday at the American Heart Association conference in New Orleans, was stopped early because it quickly became clear that the drugs were having such a positive effect. The results showed that adults given Crestor (the statin made by AstraZeneca, which funded the study) had a 44% lower risk of cardiovascular problems than those not given the drug -- this, despite the fact that the study only looked at people with high c-reactive protein (CRP) levels but low cholesterol, meaning they wouldn't qualify for statin treatment under the current guidelines. According to the Canadian Press, the results were "hailed as a watershed event in heart disease prevention." [Canadian Press] The Wall Street Journal's Ron Winslow called it "one of the most provocative cardiovascular trials in years" and reported that the presentation of the trial results drew an overflow crowd of thousands of physicians. There's talk now of overhauling the guidelines for statin treatment. [Wall Street Journal Health Blog] The JUPITER trial's results were published in the New England Journal of Medicine yesterday [NEJM] alongside an editorial that points out all the new questions that must be answered in light of the new data. [NEJM] The news will surely lead to more jokes about putting statins in our drinking water. But JUPITER isn't without its critics. Merrill Goozner, a journalist and the director of the Integrity in Science project, pointed out that the study's lead author holds the patent to a CRP test that would receive much more use if statins are given to people with high CRP. Mr Goozner also worried that the increase in diabetes among patients taking the statin might counterbalance the positive effect on cardiovascular outcomes. His conclusion on JUPITER? "A possibly unethical trial with marginal results..." and yet another step along the path to more healthcare spending and unimproved healthcare. [Gooznews] In an ABC News op/ed, Dr Nortin Hadler wrote that the study found that Crestor's number-needed-to-treat, or NNT, to prevent one heart attack is around 100, and much higher to prevent one stroke. The overall results of the trial, wrote Dr Hadler, are too small to get so worked up over: "I doubt the small effects are real and therefore have no interest in taking Crestor." [ABC News]

A new Canadian study reported that you should order your steak rare -- it just tastes so much better! Just kidding. But the study actually did determine that eating well-done red meat instead of medium or rare meat raises men's risk of colorectal cancer by 57%. [Cancer, Epidemiology, Biomarkers & Prevention] That's much higher than the 20% increase reported by an American Association for Cancer Research study in 2001. [American Cancer Society]

Sometimes doctors want to know their patients' ethnicities in order to predict certain risks associated with some ethnic backgrounds. (For instance: Crohn's in Jewish patients or sickle-cell anemia in black patients.) But a new study revealed that asking patients won't necessarily yield an answer a doctor might expect: researchers from the BC Cancer Agency discovered that what patients tell their doctors their ethnic backgrounds are, and where they were born, often do not correspond, particularly in distinguishing between western, eastern and northern European. [Asian Pacific Journal of Cancer Prevention]

Migraines may be painful but it turns out they could actually a blessing in disguise. The headaches are associated with lower breast cancer risk in postmenopausal women, according to a new study. [Cancer, Epidemiology, Biomarkers & Prevention] [Reuters]

Last year, music-loving cardio patients had a minor scare when research showed that iPods can interfere with pacemakers. [Heartwire] Then, earlier this year, another group of researchers confirmed the interference but reassured patients that using an MP3 player is perfectly safe. [CBC News] But now a new study found that it's not the music devices that are the problem -- it's the headphones that are causing interference. [Reuters] The message: don't hold your headphones directly over your heart. [Associated Press]

The Canadian Medical Hall of Fame has inducted five new members:

  • Sylvia Fedoruk: medical biophysicist, developer of the Cobalt Bomb therapy (not to be confused with the other cobalt bomb, a theoretical atomic weapon) and expert curler
  • Tak Mak: biochemist, cancer researcher and immunology specialist
  • Ronald Melzack: chronic pain psychologist and author of the world-famous McGill Pain Questionnaire
  • Charles Tator: neurosurgeon and specialist in spinal cord injury prevention
  • Mladen Vranic: endocrinology and insulin researcher
More information on new hall of famers is available on the official website. [Canadian Medical Hall of Fame news release (PDF)]

The Boston Globe analyzes the overdose suicide of a drug-addicted anesthesiologist, a young doctor who had struggled with rehab and was found dead last month in a closet in a Boston hospital. Anesthesiologists are overrepresented (by four or five times the norm, according to one count) in the figures of doctors who suffer from addiction, and some hospitals are experimenting with random drug testing. [Boston Globe] Dr Kevin Pho wondered whether random drug testing should be adopted more widely. [KevinMD] Another blogger commented on the story as well, lamenting the lack of support doctors get in order to stay healthy. [Notes of an Anesthesioboist]

Neil Seeman, a health system researcher at the University of Toronto, wrote an open letter to his former boss, Prime Minister Stephen Harper, asking him to follow Arnold Schwarzenegger and Michael Bloomberg's governing styles in order to create a "post-partisan" public health policy. [Longwoods Healthcare Blog]

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