Canadian Medicine will return on Monday, January 5.
Edmonton is suffering from a series of outbreaks of norovirus in hospitals, nursing homes and child-care centres, according to a health advisory released yesterday by Alberta Health Services. There have been 20 outbreaks in the city in December. [Alberta Health Services advisory] Associate medical officer Dr James Talbot said the holidays could help spread the virus. "It’s a time," he cautioned, "when people get together in groups and they serve food." [Edmonton Journal]
The economy is pretty rough in Canada these days, wrote Canadian Medical Association President Dr Robert Ouellet (right) in his holiday greetings message to physicians. But the news isn't all bad, he said: after all, we're not nearly as screwed as the Americans! Merry Christmas and a Happy New Year, everyone! [CMA]
Giving statins to patients before they undergo heart surgery reduces the risk of their developing post-op delirium from 20% to 13%, write a multidisciplinary team of University of Toronto and German researchers in an article to be published in next month's issue of Anesthesiology. "[T]o the best of our knowledge," they write, "this is the first report identifying an association between preoperative statin therapy and postoperative delirium in a cardiac surgical population. A double-blind, randomized, placebo-controlled clinical trial would be required to validate these findings." [Anesthesiology]
Just as many Ontario general surgeons consult the internet for information on medical evidence and guidelines as consult their colleagues. [BMC Medical Informatics and Decision Making (PDF)]
Vasovagal syncope may have a genetic origin, suggest two University of Calgary researchers in an article to be published next month. [Current Opinion in Cardiology abstract]
The Toronto Star examined the language barrier between immigrants and their doctors. [Toronto Star]
Innovation Canada, a government-funded science research funding body, put together its list of the coolest research in 2008. The list includes bionic arms, a CPR glove, and more. [InnovationCanada.ca]
After Dr Stephen Harley, of Dartmouth, Nova Scotia, was found to have prescribed drugs for himself, he had restrictions posed on his licence to practise and lost his narcotics prescription permit. At a College of Physicians and Surgeons of Nova Scotia disciplinary hearing earlier this month "Dr. Harley immediately acknowledged he had been diverting prescription medication for his own personal use." [CPSNS decision (PDF)] [Halifax Chronicle-Herald]
When I get emails with titles like "Penis Extender Certified by Canadian Health Authorities" I typically hit MARK AS SPAM right away. But when "Penis Extender Certified by Canadian Health Authorities" arrived today, it looked halfway reputable. It turned out not to be spam at all, but rather the announcement that the Andropenis, a frightening-looking "penile traction device" that promises 3-4 cm more length, has been certified by the Canadian Medical Devices Conformity Assessment System. The Andropenis also has some more traditional medical indications, for the treatment of Peyronie's disease and to reduce post-operative scar retraction. [Andromedical Canada] I couldn't find the original documentation on the certification, so I guess we'll have to take the makers of Andropenis at their word for now. Unless perhaps I've been taken in by a particularly effective spammer...
A new product called Diet Coke Plus -- cola infused with some vitamin B, zinc, niacin and magnesium, which is being marketed as "Diet Coke with Vitamins & Minerals" -- has got the US Food and Drug Administration's hackles up. The FDA informed Coca-Cola this month that its new Plus drink's name violates the law. Diet Coke Plus "makes a nutrient content claim but does not meet the criteria to make the claim," the FDA said, adding that the regulatory agency "does not consider it appropriate to fortify snack foods such as carbonated beverages." [FDA warning letter] "If the label says it's healthy then it must be true," snickered Forbes's Lisa LaMotta. [Forbes]
Sai-Man Tang, an Ontario man studying medicine in England, has been sentenced to one year in jail for importing child pornography. Justice Roydon Kealey called his case "most tragic and difficult criminal case" he'd ever heard, given Mr Tang's academic excellence in England and at Harvard, where he was doing graduate work. [Ottawa Citizen]
Perennial failed US presidential candidate Ralph Nader will speak at the University of Toronto on January 30 on the subject of "importance of a publicly funded health care system and the importance of preservation of Canada’s jewel of a system." Tickets are $19.62, in memory of the year Mr Douglas set up Canada's first universal, publicly funded healthcare system in Saskatchewan. [Bring Back Tommy]
Photo: CMA
Latest headlines
Wednesday, December 24, 2008
What's in the news: Dec. 24 -- Holiday analgesia
Tuesday, December 23, 2008
What's in the news: Dec. 23 -- The world's most unhealthy burger
An outraged Dr Yoni Freedhoff, the Ottawa obesity specialist who blogs at Weighty Matters, describes Disney's latest accomplishment: the creation of the "world's vilest burger," a cheeseburger squished between two miniature pizzas instead of a bun. [Weighty Matters] I respectfully dissent, and would like to submit for Dr Freedhoff's consideration the Luther Burger (named after the musician Luther Vandross), which features a bacon cheeseburger on a grilled, sliced glazed donut. [Wikipedia] [Photo from Grocery Eats] Another good candidate for the title of world's most unhealthy burger is the deep-fried cheeseburger. [Cheese-burger.net]
Family physicians' "lifestyle interventions" -- which translates to telling patients to get some exercise, don't eat too much junk food, etc. -- don't appear to do much good for patients at low risk of cardiovascular problems. "In general, while it is difficult to suggest that primary care providers not counsel all their patients on healthy lifestyles, their time might be better spent focusing on those at higher risk," found a pair Newfoundland researchers, in their systematic review published this month. [Canadian Family Physician]
A former president of the College of Physicians and Surgeons of Alberta was killed over the weekend when her husband's plane crashed in Colorado. Family physician Sheila Malm, whose husband, oil company consultant Gerrit Maureau, was flying, was 65. "There are some people who wake up in the morning and just give all day," Dr Juliet Guichon, a senior associate in the University of Calgary's bioethics office, where Dr Malm used to work as well, told the Calgary Herald. "When she saw a patient, she worked hard to see the patient in a complex web of relationships, rather than seeing the patient as an isolated human. That's how you give better care." [Calgary Herald]
Health Canada has issued a safety warning about the increasingly common off-label use of the cancer drug bevacizumab (Avastin) to treat age-related macular degeneration by injecting it directly into patients' eyes. The warning, which reminds doctors that the drug was never evaluated for use in the eyes, said, "As of November 26, 2008, Roche has been made aware of 25 spontaneously reported Canadian cases of eye inflammation, endophthalmitis, blurred vision, and floaters, some of which have been described as Toxic Anterior Segment Syndrome (TASS), in patients who were administered aliquots of AVASTIN Lot B3002B028 intravitreally." [Health Canada MedEffect]
A recent labour-mobility agreement between the medical regulatory bodies in Quebec and Ontario has some authorities on the Quebec side of the border concerned that doctors are going to see greener grass in Ontario. Some specialists could earn up to 30% more in Ontario than they do in Quebec. [CBC News]
In the wake of the death by freezing of André Gagnon, a homeless man, in Montreal, Quebec Health Minister Dr Yves Bolduc has been put on the defensive on the question of the amount of funding the provincial government contributes to homeless shelters. [La Presse] Montreal shelters receive $12 per bed per night from Quebec, whereas Toronto shelters receive $61 from Ontario, according to the head of Montreal's Old Brewery Mission shelter, where Mr Gagnon was last seen before he died. [Montreal Gazette] "We invest four times more than was invested in 2003 for shelters," Dr Bolduc told La Presse. "The condition of the homeless is something that we have been concerned with but we are waiting for the results of a parliamentary commission to decide on our action plan." Dr Bolduc also disagreed with the comparison with Toronto. Meanwhile, $24 million in new funding was announced Tuesday to combat poverty in Montreal, but some people were disappointed that none of the money was dedicated to homeless shelters. [Montreal Gazette]
Too many young Quebec GPs are starting their careers working in hospitals and emergency departments instead of walk-in clinics, to the detriment of the healthcare system, according to a new report from the Quebec Federation of General Practitioners. [Montreal Gazette] "That newly graduated physicians would want to work in emergency, that is not surprising," said report co-author Isabelle Paré. "They're young and emergency gives them an adrenaline rush. What's more disturbing is that after three years [of practice], more of them are in second-line care, in the hospital. If that trend continues, we'll have a shortage in first-line care." [Le Soleil]
The hypothesis: "The discordance between fertility intentions and outcomes may be associated with mental health in the general population." In other words, unintended pregnancies and childlessness are both real bummers. But when two McGill researchers examined the data, it turned out that neither of those outcomes caused women psychological distress, and only the former caused distress in men. [Social Science & Medicine abstract]
Saskatchewan researchers have produced the first diffraction-enhanced imaging (DEI) soft-tissue X-rays ever in North America. [University of Saskatchewan news release]
Someone was bound to do it eventually. A Californian researcher replicated the infamous Stanley Milgram obedience experiment in which subjects were instructed to administer higher and higher voltage shocks, which they believed falsely to be real, to other subjects, in order to test their willingness to obey the instructions of the fake study's investigators. The man who has reproduced it, Jerry Burger, however, did not take it as far as Dr Milgram did. Dr Burger did not allow his subjects to administer a fake shock after it became clear the fake patient would suffer. "It was a very, very, very stressful experience for many of the participants," he said of the original study. "That is the reason no one can ethically replicate the experiment today." Dr Burger found that 70% of participants were willing to increase the voltage of a shock to the patient when asked to do so, even after seeing the patient (an actor) scream in pain. "That was surprising and disappointing," he said. [Reuters] Read more about Dr Milgram's obedience experiment. [Psychology Today]
In a new video, Dr Jock Murray, the former Dalhousie University dean of medicine, gave his take on the good and bad aspects of the Canadian and American healthcare models. "Canada gives everything to everyone, but in some instances, not right now. The USA gives everything right now, but not to everyone." [Medscape]
The holiday edition of Grand Rounds was published Tuesday. [Highlight Health]
Monday, December 22, 2008
Most popular posts of 2008
In 2008, Canadian Medicine was visited more than 57,000 times. These were the 10 most popular articles over the past year:
1. THE INTERVIEW: Dr Mehmet Oz
"I don’t think the gentlemanly approach always works. You have to shake some people up. The reason for that is that our biggest enemy in educating people about their bodies in Canada and in America, is that they think they already know the answers. And they don’t." ... On Oprah’s heart: "She has a beautiful heart. It’s pristine. It has no blockages and functions very elegantly."
2. Grand Rounds 4:25
Sultry nurses seduce patients; training to become a doctor is akin to learning to sign opera; and the best hospital cafeteria in Canada, with caribou stew on the menu. (No kidding.)
3. What really killed Jane Austen?
Was it the vapours? Acute Darcyitis? A bilious attack?
4. Canada's greatest medical research
Canada has produced a disproportionately large number of major biomedical breakthroughs. This report exhaustively catalogues the best of the best. You probably knew about Dr Frederick Banting's discovery of insulin, but you're sure to be surprised at some of the high-profile research mentioned in the report, like robot surgeons, music therapy for the physically disabled, induced hypothermia for heart surgery patients and "cobalt bombs," to name a few of the most interesting items.
5. Vasectomies by Dr Dick Chopp, and more physician aptonyms
Dr Richard "Dick" Chopp performs vasectomies at a urology practice in Austin, Texas. He even gives out T-shirts to vasectomy patients. On the back, they read "I was 'chopped' at the Urology Team." Classy... Dick Chopp isn't the only doctor with a medically appropriate (or inappropriate, as the case may be) moniker -- there are plenty more, including a few Canadians as well.
6. Q&A: Why tech journalist just had to try body modification
San Francisco journalist Quinn Norton had a magnet implanted into her fingertip. "When my GP asked why I'd had it done, I told him it was to get a sense for electro magnetic fields, live wires, spinning motors, and the like. He asked me why I'd want that? I was at a loss. I wasn't sure how to explain it, other than to say, why wouldn't you want a completely new sixth sense?"
7. Vancouver Island plans clean crack pipe program after new study shows need
Coinciding with the release of a new study from the University of Victoria that found hepatitis C can be transmitted on shared crack pipes, the Vancouver Island Health Authority has announced it will provide clean crack pipe mouthpieces and filters to addicts at needle exchange sites beginning April 1, 2008.
8. Is universal healthcare an illegal, dangerous monopoly? One Ontario lawsuit argues 'yes'
Adolfo Flora, whose first legal appeal in his case against the government-operated Ontario Health Insurance Plan (OHIP) was dismissed last year, is back at it again. His lawyers insist that Ontario's universal healthcare system is putting citizens' lives in danger. (OHIP provides universal healthcare insurance; OHIP has a monopoly over healthcare insurance; monopolies are detrimental to the public good; ergo OHIP is detrimental to the public good -- so goes Mr Flora's argument.)
9. Doctors must kill the skunk, says bioethicist
When Toronto neurosurgeon and bioethicist Mark Bernstein encountered a wounded skunk in the middle of the road on his drive to work, he considered his options. "I figured I had four: 1) I could stop and pick it up and drive to an all-hours veterinary clinic (I knew the whereabouts of one due to a recent illness in one of my two Labradors); 2) I could keep driving and forget about it; 3) I could call 911 or information to get a number for the humane society (assuming they have an after-hours number); and 4) I could try to somehow put the poor thing out of its misery." You can probably guess where this story is going.
10. THE INTERVIEW: Dr Brian Goldman, host of the CBC radio show White Coat, Black Art
"We devoted a half a show to whether a real-life House would be able to practise medicine in the real world... Probably 10 or 15 years ago he would have been able to, but now that doctor would be put out on his ass pretty quickly. I’ve heard of a surgeon who flung scalpels at OR nurses. You’re not allowed to do that anymore."
What's in the news: Dec. 22 -- Christmas gift packaging injuries
A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, December 22.
Plastic Christmas-gift packaging every year results in hospital admissions for lacerations and puncture wounds on Christmas Day every year. "That clamshell packaging is absolutely diabolical," said Colorado emergency physician David Ross. Another potential packaging-related diagnosis: "wrap rage." [American Medical News]
A group of 18 Newfoundland and Labrador specialist physicians has gone public with concerns about the province's inability to retain and recruit medical specialists to the province. The 18 physicians were excluded from wage increases offered recently to certain specialists. "The only way you're going to get more people like us is to ante up a little, unfortunately," Mark Stefanelli, a neurologist, told The Telegram. They want a 35% raise, instead of the 20% they expect to receive. [St John's Telegram]
This flu season is presenting problems for public officials: some flu viruses have been found to be oseltamivir-resistant while others are amantadine- and rimantadine-resistant. None of the common strains appear to be resistant to zanamivir, though that drug is contraindicated in children under seven and some adult patients. [Canadian Press] For more information on this year's flu virus drug resistance and current trends, see the latest FluWatch from the Public Health Agency of Canada. [PHAC]
Maple Leaf Foods agreed to an out-of-court settlement with patients who had initiated class-action lawsuits against the company after an outbreak of listeriosis killed at least twenty Canadians earlier this year and infected many more. The total amount of the settlement is between $25 million and $27 million, with individual payouts ranging from $750 for a one- or two-day-long illness to more than $200,000 for the families of people who died as a result of their infections. [Toronto Star] Before the 2008 listeriosis scare, 6% of Canadians said they would not eat deli meats; after, that figure jumped to 39%, according to University of Guelph researchers. [Hamilton Spectator]
Two cases of flesh-eating disease, or necrotizing fasciitis, around the bellybuttons of Alberta infants born a day apart this summer were not connected, an internal review concluded. One of the babies died. [Calgary Herald]
One of the most effective ways to control the spread of HIV in prisons is to provide a needle exchange program and opioid substitution therapy, a Quebec consultant reported in the January 2009 issue of The Lancet Infectious Diseases. [The Lancet Infectious Diseases abstract] The Conservative government last year decided not to follow the advice of the Public Health Agency of Canada to institute a Prison Needle Exchange Program. [Canadian Medical Association Journal]
Alberta's Ministry of Health and Wellness is projected to run a $1.3 billion deficit over the next year. "They're always the large elephant in the room," said Premier Ed Stelmach of the ministry. "It just seems like every area we deal with, when we take a look at it... quite frankly you could do it another way that makes it more efficient," said Health Minister Ron Liepert of a recent report intended to save money in the province's healthcare system. [Canadian Press] Mr Liepert's planned reforms got a ringing endorsement from the Calgary Sun's Rick Bell, who declared in his headline, "The only physicians who have to fear Health Minister Ron Liepert are the spin doctors -- all he wants is to make the system run better". Mr Bell was impressed with Mr Liepert's honesty that the public healthcare system may not be able to cover everything. "There is no plan at this stage for us to not cover something in the future," Mr Liepert told him. "But I'm reviewing everything. It would be irresponsible for us not to look at all aspects of the health system. That review needs to take place. For every dollar we spend, are we certain we need to spend it? I have to ensure the dollars I ask for are justified." [Calgary Sun] Mr Liepert also chatted with the Edmonton Journal, for the paper's long, in-depth profile of him. In case you haven't heard him say it enough yet, he's sick and tired of consultations and studies. "You assess the pros and cons and make a bloody decision," he declared. "Ralph Klein did all sorts of consultations... How much success did they have? How much did health care change under Ralph Klein? So why would we follow the same path he did and get the same results?" [Edmonton Journal]
Charges for attempted murder have been brought against an 18-year-old who shot a man at the front entrance of a Halifax hospital last month. [Moncton Times & Transcript]
Private prescription drug insurance plans, as exist in most of Canada, result in inequitable care provided by physicians in the public system, reported a new study by McMaster University economics and epidemiology professor Jeremiah Hurley and London School of Economics researcher Sara Allin in Health Economics. [Health Economics abstract] In another article, this time with the Mental Health Commission of Canada's Gillian Mulvale, Dr Hurley found that Canadian mental health patients without private drug insurance plans were less likely to be receiving pharmaceutical treatment for their illness. [Journal of Mental Health Policy and Economics abstract]
Leslie Iwerk's Oscar-nominated short documentary, Downstream, has upset Alberta Minister of Culture Lindsay Blackett. The film, whose central character, family physician John O'Connor, was intimidated and investigated after he reported a cluster of unusual cancers near the oil-sands industrial developments in northern Alberta, received a $67,000 grant from the province. Mr Blackett claimed he didn't know the film's subject when the grant was approved; if he had, he told CBC News, he might not have given out the money. "[W]e're looking at now how do I get more information about it because — oh, it's a film about Alberta, it's a film about the oilsands — but who knew what it meant at the time?" Displaying a phenomenally questionable understanding of the role of arts grants, Mr Blackett explained, "Because if I'm going to actually invest money on behalf of Albertans into a film, the whole idea is to show Alberta in a better light, to create an economic diversification to help them, so anything that's going to be negative is only going to be a negative impetus on this province." [CBC News] He quickly renounced that position, resorting to the tried and true excuse that his quotes were taken out of context. "There is no provision now for any type of control over content, and we have no plans to institute any control over content," he told Fort McMurray Today. [Downstream is] "one of hundreds of different films that get produced, and we’ve got to have thicker skin," he said. [Fort McMurray Today] [Edmonton Journal] [Los Angeles Times] I wrote about Downstream and Dr O'Connor in October. [Canadian Medicine]
Nicole Eaton, the director of the St Michael's Hospital Foundation, and Irving Gerstein, the former chair of the Mount Sinai Hospital board, are Prime Minister Stephen Harper's two new Senate appointments in Ontario. Mr Harper appointed 16 other people to the Senate across the country, including journalists Mike Duffy and Pamela Wallin. [Maclean's]
Physicians at the Toronto General Hospital performed the world's transplant of lungs repaired while outside of the donor's or recipient's bodies. Their methodology could "easily double or triple the number of [donor] lungs used today," said Dr Shaf Keshavjee. [Canadian Press]
The New Brunswick government met with the province's nursing association to work on a strategy to attract foreign nurses. [CBC News]
A faster heart rate and breathing rate can predict post-traumatic stress disorder, a team of Australian psychiatrists wrote in last month's Journal of Clinical Psychiatry. Reducing "acute arousal immediately after trauma... may limit PTSD development in some individuals," they suggested. [Journal of Clinical Psychiatry abstract] [Reuters]
British scientists screened a bunch of embryos and chose one that didn't hold a gene that could predispose the child to breast cancer. The baby is due to be born next week. [BBC News]
"Now all they need in universal death care," snickered Milwaukee columnist Patrick McIlheran after he read about the patient who died in a Montreal walk-in clinic's waiting room after nobody attempt to perform resuscitation. "That happened in Quebec, where they do have universal, government-supported health care for all... It’s just, of course, that there’s no guarantee you’ll get any in time." [Milwaukee Journal Sentinel] But one blogger reminded Mr McIlheran that that the doctor in question, Jacques Chaoulli, is in fact opted out of the province's public healthcare system. "That's right," wrote Illusory Tenant. "McIlheran has selected the alleged negligence of a physician that derives his livelihood from U.S.-style private insurance plans as an example of how bad a public health care system is." [Illusory Tenant] You can read my earlier coverage of the case if you missed it before. [Canadian Medicine]
Why was a longtime Manitoba family medicine leader suddenly let go?
Dr Larry Reynolds, a senior member of the University of Manitoba family medicine faculty and the Winnipeg Regional Health Authority management, was surprised to be informed in October that his contract with both organizations would not be renewed.
But why? Even Dr Reynolds hasn't been told. As he, along with the Canadian Association of University Teachers and a handful of Manitoba activists and journalists, presses for answers from the government, several competing theories have emerged:
1. He didn't get on board with the health authority's agenda. He voiced his opposition to the government's 2004 decision to close the low-risk obstetrics ward at the Victoria General Hospital, in Winnipeg, and for "speaking out about the concerns of family doctors." (He was reportedly scolded by his employers for writing a letter to the Winnipeg Free Press about the province's family medicine policies.) This is the theory espoused by Dr Reynolds himself. "I may have offended some people by speaking strongly about something I feel strongly about," he told CBC News. It is supported, in part, by Winnipeg Regional Health Authority vice-president Dr Brock Wright: "He did have a tendency sometimes to take his concerns directly to the minister, directly to the government, without letting us know in advance that he was doing so," the Winnipeg Free Press quoted Dr Wright as saying. "That's not really appropriate for someone in an administrative role -- they're expected to bring their concerns right to us." Manitoba Liberal Party leader Jon Gerrard, a physician himself, has spoken out publicly to criticize the university for not giving Dr Reynolds tenure and the freedom to voice his opinions freely -- going as far as calling the situation a government "ban on free speech" -- and the Canadian Association of University Teachers has established an ad hoc investigatory committee to "look into allegations that Dr. Larry Reynold’s academic freedom and the University’s policies on 'Appointment of Heads of Departments' were violated in the recent head selection process in family medicine."
2. He was, plain and simple, a bad boss. He "inappropriately delegated tasks and made disrespectful comments about his subordinates," Dr Wright told the Free Press. Performance reviews showed that he was not a "team player" and had leadership problems, according to Dr Wright. "Wright said one of the family doctor's subordinates retired from her administrative role early because she had trouble working with him," reported the Free Press, "and a number of people complained that Reynolds breached the WRHA's respectful workplace policy... Wright claimed Reynolds inappropriately delegated tasks, and made disrespectful comments about his subordinates."
3. The institutional criticism wasn't the real problem -- it was his opinions on medical ethics. "Univ. of Manitoba: Giving the Boot To Pro-Life Doctors," read the headline above a copy of the letter sent to the school and government officials by Social Conservatives United director John Pacheco. "In what was obviously a politically motivated decision," Mr Pacheco wrote, "the University of Manitoba has shown its intolerance and bigotry against a renowned and experienced professor and doctor because he did not tow the politically correct pro-abortion and pro-establishment line regarding family medicine." According to Social Conservatives United's blog, Dr Reynolds was a contributor to "pro-life" publications and sat on the editorial board of the Canadian Physicians for Life newsletter. There were rumours as well, the blog article said, that he may have clashed with the University of Manitoba in 2003 and 2004 when a med student was denied his degree because he said he would not refer patients for abortions. Dr Reynolds has written, "Physicians must be able to maintain their integrity and consciences and to decline to participate in care that they reasonably believe to be harmful to the patient or to others. To do otherwise would herald the twilight of medicine as a noble and compassionate profession."
If we choose to believe Dr Wright's stated reasons for not extending Dr Reynolds's contract, the answer is some combination of #1 and #2. But for the social conservative group, which appears to be predisposed to conspiracy theories, the real menace is the possibility that #3 is what sparked the decision to get rid of Dr Reynolds, and that #1 and #2 have only been trotted out publicly as a pretense. It is telling, however, that Dr Reynolds has not suggested in any of his statements so far that #3 has any merit.
Friday, December 19, 2008
What's in the news: Dec. 19 -- Common pelvic pain drug is useless: study
A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, December 19.
A drug commonly prescribed to treat for chronic prostatitis/chronic pelvic pain syndrome in men, alfuzosin, turns out not to be any more effective than placebo, a Queen's University study reported in today's New England Journal of Medicine. [NEJM abstract] "In medical research, it is as important to find out which treatments are effective, as well as those which are not beneficial," Griffin Rodgers, the director of the US National Institute of Diabetes and Digestive and Kidney Diseases, said in a release. "Now researchers can focus their efforts on more promising therapies." [Queen's University news release]
The first-ever transmission of vaccine-derived polio in a developed country, identified in an Amish infant in Minnesota, was reported by a team of Canadian, American and British researchers. [Journal of Infectious Diseases abstract]
Economic uncertainty has prompted the British Columbia Ministry of Health to ask the province's health authorities to delay submitting their service plans by two months, a move that created no small amount of confusion. "As a result of the current challenges in the economy, it's taking a little longer this year to define what the allocations might be. The discussion is being deferred until February which will still allow health authorities time to plan accordingly," a government spokesperson told The Tyee. NDP health critic Adrian Dix pounced immediately, telling the news website, "Presumably what this means is not that they won't be planning, but that they won't be planning on paper in a way that will embarrass the government... Clearly the health authorities as created by the Premier are not working very well... The Premier said he was going to bring new management and instead he's brought chaos." [The Tyee]
A $30 million class action lawsuit against The Ottawa Hospital has been launched on behalf of cancer patients who received smaller doses of radiation than they had been prescribed because a machine was not been calibrated correctly. [Connally Obagi LLP news release]
A Canadian-designed blood test for variant Creutzfeldt-Jakob disease (vCJD) achieved 100% sensitivity and 100% specificity in a recent British trial. "The company has 50,000 test kits available to begin large-scale testing to determine the fraction of the population infected with vCJD," CEO Dr George Adams said in a release. "This information is vital for determining the need for routine testing of blood donations."[Amorfix Life Sciences news release]
In the United States, the Bush administration pushed through a new "conscience rule" to protect health workers from being forced to perform procedures that violate their religious or ethical beliefs, such as abortions. [New York Times] [Los Angeles Times] The rule is opposed by the American Medical Association and pro-choice groups, who argue that the rule will limit women's access to abortion services. President-elect Barack Obama has hinted, however, that he doesn't approve of the rule and may overturn it when he takes office next month. [Wall Street Journal] Conscience protection rules exist across Canada, and are reinforced by the Canadian Medical Association's conscientious objection policy, which earlier this year came under fire from both pro-choice and anti-choice activists. [National Review of Medicine]
A new book, When Baby Brings the Blues: Solutions for Postpartum Depression, by Toronto psychiatrist Ariel Dalfen, aims to teach people that postpartum depression can be treated successfully. [When Baby Brings the Blues: Solutions for Postpartum Depression] "The major thing I want to impart to people is how treatable it is and how it's not something to keep to yourself and suffer in silence for months on end, which is what a lot of people unfortunately do," Dr Dalfen told CTV.ca News. [CTV.ca News]
Doctors, nurses and health professionals are the most desirable people to marry, although they're not perceived as being as smart as people who work in science and technology, according to a new survey conducted in Canada, the US, and five other countries. [MSNBC] [Synovate professions survey]
Anne Lawrence, of the University of Lethbridge's psychology department described a case of "anatomic autoandrophilia," a type of "erotic target identity inversion" in which someone is sexually aroused by the idea of changing one's body to become more like the people one is attracted to. [Archives of Sexual Behavior abstract]
Thursday, December 18, 2008
What's in the news: Dec. 18 -- Dr Keith Martin's Zimbabwe crusade
A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, December 18.
In the absence of significant international and Canadian aid to Zimbabwe, Liberal MP and former physician Keith Martin has arranged, in collaboration with nonprofit charities and independent of the government, to send a large shipment of medical supplies to rural Howard Hospital, run by Canadian expatriate Dr Paul Thistle. "I went to the most senior people in the organization [the Canadian International Development Agency]. I was told `it's the end of the year, we can't do it,'" he told the Toronto Star's Carol Goar. "I pressed and the only answer I got was `sorry, we can't help right now.'" [Toronto Star] New figures revealed that Zimbabwe's cholera epidemic has killed 1,111 people and infected over 20,000 since August, amidst a crumbling healthcare system, starvation and shortages of medicine. [Reuters]
Health Canada's earlier warning not to give over-the-counter cough medicines to children under two has been expanded to children under six. [Health Canada news release] The Nonprescription Drug Manufacturers Association of Canada tried to put as positive a spin on the story as they could in their somewhat chagrined-sounding response: "While the safety of these products has been directly evaluated in children for decades, their effectiveness has historically been established through studies conducted in adults. Health Canada has determined that there is a need for new clinical trial data to directly establish the effectiveness of cough and cold medicines in children." [NDMAC news release]
Dr Yves Bolduc was reappointed Quebec's minister of health today as Premier Jean Charest presented a stable, mostly unsurprising cabinet. [Montreal Gazette] The union coalition Centrale des syndicats du Québec said Dr Bolduc is "under surveillance" and must do more to convince Quebeckers that the government will protect the public healthcare system from privatization. [CSQ news release]
Nova Scotia is researching whether it can pay for Toronto rent for 10 patients who needed to be sent to the city for lung transplants. [CBC News]
The Nobel Prize committee is under criminal investigation by a Swedish anti-corruption prosecutor over allegations that AstraZeneca could have influenced the decision to award a share of this year's Nobel Prize in medicine to Dr Harald zur Hausen, in recognition of his work on vaccination for the human papillomavirus (HPV). AstraZeneca, which holds the patents for ingredients used in the two HPV vaccines in production, Gardasil and Cervarix, funds two Nobel subsidiaries, called Nobel Media and Nobel Web. In addition, Bo Angelin, who is on the Nobel committee, also sits on AstraZeneca's board of directors, and another committee member worked as a consultant for the company as recently as 2006. AstraZeneca told the Toronto Star there had been no corruption. [Toronto Star] [Newsmax]
University of Western Ontario researchers announced the development, and licensing, of a new high-tech screening tool to identify pregnant women at risk of preeclampsia. [Western News]
Researchers were surprised to find methicillin-resistant Staph aureus (MRSA) in 3.2% of Ontario schoolteachers, a new study reported. [Canadian Journal of Infectious Diseases & Medical Microbiology]
A tobacco ad placed next to the comics in last Friday's Ottawa Citizen prompted Physicians for a Smoke-Free Canada, the Canadian Medical Association, and five other groups to call for a complete ban on tobacco advertising. [news release]
Health policy analyst Steven Lewis published an essay on Longwoods's website that is sure to provoke controversy, in which he blames the way doctors' interests have been allowed to supersede the interests of the healthcare system as a whole. "We owe the doctors of Canada a serious apology for spoiling a noble profession. By kowtowing to organized medicine, we end up with collective agreements and policies that entrench the status quo and keep Canadian healthcare in the dark ages," he wrote. "[P]ower corrupts, and we have given organized medicine too much power... Collectively, physicians are worse than the sum of their parts, and that harms all of them, and us. Our mistake has been to give organized medicine what it wants. It is time to give it what it needs, and to help it understand the difference." [Longwoods]
Don't miss the British Medical Journal's clever and funny holiday content. [BMJ]
Weighty Matters, written by Ottawa physician Yoni Freedhoff, was voted Canada's best health blog of 2008. [Canadian Blog Awards]
$400k spent on hip-hop for Nunavut children's health
The federal government and the territorial government of Nunavut are splitting the $400,000 cost of setting up hip-hop workshops to promote healthy lifestyles to Nunavut youth and fight suicide and crime, the Nunatsiaq News reports.
The spending was announced last week by federal Health Minister and Nunavut MP Leona Aglukkaq and Nunavut Premier Eva Aariak. The program will produce healthy eating and exercise kits to be distributed to Nunavut schools, said Ms Aglukkaq. "Hip hop reaches out to youth, including youth at risk, and teaches them to respect themselves, their peers and their communities," Ms Aariak told the News.
The workshops are to be run by a Ottawa-based consulting firm called Blueprint for Life, which was founded by social worker Stephen Leafloor, also known as Buddha (pictured above, right, striking an incongruous pose next to an inukshuk), to provide "social work through hip hop."
The Nunatsiaq News article called the $400,000 spending a "splurge" on "high-priced hip hop." Given the drug violence and crime that corrupted much of American hip-hop culture when artists began pulling in large sums of money, resulting in a string of high-profile murders in the 90s, it's uncomfortably ironic to find this among the featured photos on Blueprint for Life's website:
Photos: Blueprint for Life
Wednesday, December 17, 2008
What's in the news: Dec. 17 -- Doctor becomes new AB opposition leader
A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, December 17.
Dr David Swann has been elected leader of the Alberta Liberals by a wide margin. Dr Swann is best known for being fired from his pre-politics job as a public health official by the Progressive Conservative government for his vocal support of the Kyoto Protocol, and for staging a hunger strike in Ottawa last year to protest the Canadian government's failure to act to protect the people of Darfur. Of particular importance to note is Dr Swann's flirtation with the idea of abandoning the party's name, presumably to jettison any association with the unpopular-in-Alberta federal Liberals. Before announcing his candidacy for the party leadership, he appeared to toy with the idea of creating an opposition coalition party before giving up on the idea. But Edmonton Sun columnist Neil Waugh said yesterday that Dr Swann's "odd coalition" has nevertheless come to pass. "[W]hat the Liberals got, after their party apparently got hijacked by a dodgy coalition of non-governmental organizations and radical environmentalists who backed Swann, may bear little resemblance to what they once had," wrote a very cynical Mr Waugh, who also advanced the theory that a party name change could still be in the offing. [Edmonton Sun] In today's Calgary Herald, Naomi Lakritz offered a rather odd endorsement of Dr Swann and the Liberals and wondered why he is so often referred to as "eccentric." [Calgary Herald] The Herald's Jason Fekete gave Dr Swann a rather rough welcome to the leader's seat, citing his "steep learning curve" after witnessing an awkward series of PR goofs. [Calgary Herald]
Newfoundland and Labrador's sole HIV/AIDS clinic is in danger of being shut down in a matter of months after the province's only infectious-disease specialist, Dr Mazen Bader, who runs the clinic, announced he is leaving in March. His departure follows that of the province's other ID physician, whose position, vacated last year, still hasn't been filled. "The earlier resignation of the other specialist likely played a role in Bader's decision to quit because his workload had doubled," guessed The Telegram. If a replacement can't be found before Dr Bader leaves, HIV/AIDS patients may be seen by internists and family physicians, a local health official said. "They will not be thrown to the wind." [The Telegram]
Canadian police are beginning to put away their Tasers as safety concerns -- and accidental deaths -- mount. "There have been officers who don't want to carry a Taser because they don't want to be placed in a controversial situation," one Edmonton detective testified at a recent disciplinary hearing about misuse of the weapons. [Edmonton Journal] In Ottawa, the Liberals and the NDP called for a temporary suspension of the use of Tasers by police officers across the country until the government acts on recommendations made in a review by the House of Commons Committee on Public Safety. [Liberal Party news release] "Unfortunately now, with over 20 deaths, it's incredibly obvious to anyone who looks at the situation, that we've got to mark a pause for the use of the taser right now, simply because it's been proven abundantly clear that they're too dangerous to be used without proper rules. And we don't have proper rules," NDP deputy leader Thomas Mulcair told the Times & Transcript. [Moncton Times & Transcript]
A huge international study investigating the potential connection between cell phone use and cancer is now two years late, and the Canadian contingent has declined to release its results as eight of the twelve other countries have already done. "There is a lot of data that's been obtained, but not all of it, and the people sitting on it are being obstructionists for a particular reason," said Columbia University professor Martin Blank, whose request that all the results to be released as soon as possible has been met with silence. "They don't want the results to come out. It's as simple as that." [Toronto Star]
New Brunswick Health Minister Mike Murphy is endangering patients by continuing to delay a decision on filling the director's position of the provincial trauma program. Only one application has been received in 10 months -- that of Dr Andrew Trenholm -- yet the deadline has been extended another year. "To me, he is the obvious choice and also the most qualified," said Conservative health critic Margaret-Ann Blaney. "I'm amazed he's even still here." [Saint John Telegraph-Journal] An open letter to the minister, by Dr Donald E Craig, the president of one of New Brunswick's medical staff organizations, yesterday asked for the government to take action soon. [Saint John Telegraph-Journal] And one of Dr Trenholm's former patients, Donald Thomas, the mismanagement of whose case inspired the creation of a centralized provincial trauma unit, asked in an opinion article, "Mr. Murphy, do you realize that your silence vis a vis his application as chair of the trauma system is a slap across the face of a man of the highest calibre in health care?" [Saint John Telegraph-Journal]
After yet another temporary shutdown of Ontario's Chalk River nuclear plant last week forced doctors to move up tests last weekend to ensure radioactive contrast materials were available, the facility has reopened and resumed producing the necessary radioisotopes used in medical diagnostic imaging. The doctors' concerns were prompted by the extension of a planned five-day shutdown by just a day and a half. [Canadian Press] [Toronto Star] The shutdown and subsequent panic have restarted debate about the absence of contingency planning for the Chalk River plant, which is crucial to the entire world's supply of medical radioisotopes. [Globe and Mail]
A report released today by the Canadian Forces ombudsman's office finds fault with the military's handling of post-traumatic stress disorder (PTSD) in soldiers and veterans. The report, entitled A Long Road to Recovery: Battling Operational Stress Injuries, found that only 13 of the 31 recommendations made in a 2002 report on improving the Canadian Forces' treatment of PTSD have been implemented, including the very first one, which recommends "The Canadian Forces develop a database that accurately reflects the number of Canadian Forces personnel, including members of both the Regular and Reserve Forces, who are affected by stress-related injuries." [A Long Road to Recovery report] [Canadian Press] At the Canadian Medical Association's annual meeting, in August, there was a somewhat divisive resolution passed about the effectiveness of the military's PTSD screening program. As I reported then, "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." [Canadian Medicine]
Lesbian teenagers are more likely to become pregnant than heterosexual teenagers, found a University of British Columbia study published in the Canadian Journal of Human Sexuality. "These results are linked to higher rates of discrimination and harassment among LGB teens at school," said lead author Elizabeth Saewyc, a UBC nursing professor, in a release. [UBC news release] [Vancouver Sun]
After a consulting firm's review of Alberta's healthcare system recommended consolidating hospital services and converting some rural hospitals into clinics, many Albertans are worried the availability of services may become more limited. "We make no apologies that we have to look at the delivery of health care across the province and do what makes sense for the patient," Health Minister Ron Liepert told the Calgary Herald. "The media is totally focused on how much money will this save. We are doing this for the right reasons, not necessarily to save money." [Calgary Herald] Though small towns are "worried sick" about the potential scope of the closures, which reportedly threaten to start an intra-party battle between urban and rural Tory legislators [Calgary Herald], the Herald's editorial board endorsed the idea. "Albertans will hate it, and it will be a tough sell for Premier Ed Stelmach and his rural caucus," said the editorial. "But the fact remains, many medical experts, including the new Liberal Leader Dr. David Swann, believe there are too many rural hospitals... After all, how many half-empty hospitals does one province need?" [Calgary Herald]
Montreal's teaching hospitals purchased specialized software to help reduce prescription drug interactions and keep track of contraindications. [Montreal Gazette]
Digitizing radiological images could save the country's healthcare system up to $1.5 billion per year, a new report from Canada Health Infoway said. [Diagnostic Imaging Benefits Evaluation Report (PDF)] [Canada Health Infoway news release] [Sun Media]
Now we know the cause of the 2004-2006 Toronto General Hospital outbreak of multidrug-resistant Pseudomonas aeruginosa that killed 12 patients: the design of the hospital's sinks. [Infection Control and Hospital Epidemiology abstract] "The big design flaw with the sink was that the gooseneck where the water is coming out was positioned directly over the drain itself," said lead author Dr Michael Gardam, the University Health Network's director of infection prevention, told CBC News. "So when you washed your hands, that water wasn't hitting the side of the bowl first, it was hitting the drain directly, splashing inside the drain, and then causing those drain contents to splash out."[CBC News] "It's a cruel irony that in a setting where clean hands are critical, the sinks turned out to be the problem," commented the Canadian Press. [Canadian Press]
New Brunswick nurses will not go on strike over the holidays, after all. A mediator will now attempt to help the nurses' union and the government come to an agreement. [CBC News]
Prince Edward Island is well on its way to its own family medicine residency program, starting next year. [The Guardian (PEI)]
An Iraqi-born British doctor was sentenced to a minimum of 32 years in prison for his role in a car-bombing at the Glasgow airport and two attempted car-bombings in London last year. One accomplice, an engineering student, died of injuries he sustained in Glasgow. A Jordanian-born neurologist was acquitted of any crimes and is now fighting a deportation order, and another doctor was deported to India after refusing to cooperate with police. [Associated Press] After the Glasgow attack last year, we wrote about some people who insisted it should come as no surprise that doctors could be terrorists. [Canadian Medicine]
McGill psychology professor Daniel Levitin on why Christmas carols are so catchy... and why they're so damn annoying. [Wall Street Journal]
Dr Anne Berndl, an ob/gyn resident at Dalhousie and creator of the web resource www.doctorstarter.ca, has published a book on Canadian med school, So, You Want to be a Doctor, Eh? [So, You Want to be a Doctor, Eh?] [McMaster news release]
A special edition of Grand Rounds -- the best medical blog posts of 2008 -- is online. [A Chronic Dose]
A carol for Alberta's health minister
Alberta NDP leader Brian Mason (right) recently adapted a popular Christmas carol just for his counterpart, provincial Health Minister Ron Liepert.
The Calgary Herald reported, "Alberta MLAs got an early serving of Christmas music Thursday in the legislature, when NDP Leader Brian Mason -- upset with the Conservative government's health-care moves in recent years -- vented his frustration in a Christmas jingle that had politicians from all parties chuckling."
After Mr Mason read out a brief version of his version of "Twelve Days of Christmas" in the legislature, Speaker Ken Kowalski said, "The honourable member might consider sticking with his day job."
Here is the full text of Mr Mason's Alberta-healthcare adaptation:Twelve Days of Christmas Redux
On the first day of Christmas,
the health minister gave to me
A (health services board) consultant from New Jersey.
On the second day of Christmas,
the health minister gave to me
Two Tory bagmen,
And a consultant from New Jersey.
On the third day of Christmas,
the health minister gave to me
Three hospitals closing,
Two Tory bagmen,
And a consultant from New Jersey.
On the fifth day of Christmas,
the health minister gave to me
Five golden handshakes,
Four doctors fired,
Three hospitals closing,
Two Tory bagmen,
And a consultant from New Jersey.
On the seventh day of Christmas,
the health minister gave to me
Seven (David) Swanns a-walking
Six empty wards,
Five golden handshakes,
Four doctors fired,
Three hospitals closing,
Two Tory bagmen,
And a consultant from New Jersey.
On the ninth day of Christmas,
the health minister gave to me
Nine (regional) health boards fired,
Eight used syringes,
Seven Swanns a-walking,
Six empty wards,
Five golden handshakes,
Four doctors fired,
Three hospitals closing,
Two Tory bagmen,
And a consultant from New Jersey.
On the twelfth day of Christmas,
the health minister gave to me
Twelve lists a-waiting,
Eleven memos censored,
Ten private clinics,
Nine health boards fired,
Eight used syringes,
Seven Swanns a-walking,
Six empty wards,
Five golden handshakes,
Four doctors fired,
Three hospitals closing,
Two Tory bagmen,
And a consultant from New Jersey!
Photo: Brian Mason
Friday, December 12, 2008
What's in the news: Dec. 12 -- Toronto MD in an extra-scandalous sex scandal
A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, December 12.
A Toronto-area bariatric surgeon has lost his licence to practise for sexual abuse involving four of his patients, including a bizarre situation in which he used illegal drugs and had a threesome with twin sisters, both of whom he had performed laparoscopic gastric band surgery on. "Every man’s fantasy is to have sex with twins," Dr Jacobo Joffe, who worked at Scarborough Grace Hospital, reportedly told the women. Dr Joffe pleaded "no contest" to the charges. In addition to losing his licence, he must pay over $40,000 in costs to the women as well as the regulatory body. [National Post] "I went to him to help him make my life better, to help me transform," one of the four patients told a reporter. "He took advantage of that at a time when I was trusting... The worst pain is that I was seduced by my doctor." [Toronto Sun] Three months ago, on the online forum ObesityHelp.com, one patient wrote "I believe in Dr. Joffe. Yes, I have heard the latest rumours and I have put them down to a desperate woman falling for her doctor just to be rejected. I have seen it before with another wonderful doctor that I had and I have heard about other women like her who have experienced unrequited love. Totally crazy! Don't believe everything you hear or read!" [ObesityHelp.com]
The Alberta government, as well as other provincial governments, restricts private-sector involvement in healthcare to a much greater extent than it is required to by federal law, according to a new paper by University of Waterloo political scientist professor Gerard Boychuk, PhD. The paper, which reads like a blueprint for expanding private delivery and funding in healthcare, claimed that under the limits imposed by the Canada Health Act Alberta is not required to ban private delivery of services, nor is it required to prohibit doctors from working in both the public and private systems, nor does it have to outlaw private health insurance. [University of Calgary School of Policy Studies (PDF)] "I think it corrects that misperception that Alberta is a leader in encouraging private financing for health care," Dr Boychuk said of his study. Friends of Medicare director David Eggen countered, "There's a chasm between what the government would like to do and what Albertans are comfortable with and want to do." [Calgary Herald]
A bad batch of cocaine, cut with an antibiotic, has made at least 10 BC residents ill. [CBC News]
Prodding patients with sarcastic comments might help identify which ones have frontotemporal dementia, an Australian study found. [Agence France-Presse]
Ohio State University plans to provide every medical student with an iPod Touch. [OSU news release]
Dr Martina Scholtens was asked to examine her patients teeth with her stethoscope. So she did. [FreshMD]
Chaoulli back in court, but this time it's to speak about a patient's death
Dr Jacques Chaoulli (right), the man whose Supreme Court case against the government of Quebec managed to overturn sections of the province's health insurance laws, spoke yesterday in court in front of a public inquiry into the January death of a 77-year-old in the waiting room of a Montreal walk-in clinic.
The man, who reportedly presented with an ankle injury before turning "purple" and having trouble breathing, wasn't asked why he was in the waiting room before he died in his seat; he was only told to sit down. Another patient in the waiting room resorted to calling 911 for instructions on giving CPR but a nurse told her not to touch him and soon thereafter Dr Chaoulli came out to examine him, decided he could not be resuscitated, and asked a nurse to call an ambulance. "I concluded that this patient must have been dead already a long enough time - I had no way of knowing how long - but long enough," he was quoted as saying in the Montreal Gazette. He declined to move the body out of the waiting room after the call was placed because he thought it was "the scene of a crime," he said.
"It was a really unusual event and the patients had an understandable reaction of distress, even of revolt," Dr Chaoulli said. A coroner will make recommendations in several months, after the inquiry hearings wrap up, reported the Le Journal de Montréal.
The clinic where this all occurred, Clinique médicale Viau, in St. Léonard, is one of several dozen Montreal "network-clinics," a new model of healthcare delivery initiated the same year Dr Chaoulli went to court to fight against private-healthcare restrictions. Network-clinics -- which "bridge the private and public sectors," as Dr Albert Benhaim, the Chair of the Network-Clinic Table, wrote in 2006 in DRMG Express, a newsletter (PDF) published by the city of Montreal's health agency -- connect patients with doctors in both the public system and doctors who have opted out of the public system and charge their patients directly. Dr Chaoulli opted out of the public system years ago.
Photo: Liam Maloney, National Review of Medicine
Thursday, December 11, 2008
Criticism of the Ontario Medical Association continues unabated
The Coalition of Family Physicians of Ontario (COFP), which vehemently opposed the Ontario Medical Association's handling of this year's new contract with the provincial government, has not been dissuaded from its advocacy by the majority of Ontario doctors' approval of the contract.
The COFP's latest message to the province's family doctors, sent earlier this month, accuses the Ontario Medical Association of being too cozy with the government, calling its attempt to balance doctors' interests and the government's economic goals "conflicting allegiances."
The major issue, according to the COFP, is the OMA's utter failure to push the government to consider alternatives to the "unsustainable" Canadian model of universal healthcare. "Other provinces have already taken successful steps in this direction by allowing a limited two-tier approach to healthcare delivery and funding," COFP President Dr Douglas Mark wrote in his letter. "It is also the approach adopted by the rest of the Western industrialized nations, most of which have a more effective and equitable healthcare system than our own."
Here is the full text of the COFP's letter:December 1, 2008
The Ontario Medical Association has not responded publicly to the COFP's letter.
To All Ontario Family Physicians:
Healthcare in Ontario:
“Resources for some, some of the time”
There has never been a time in Canadian and Ontario medicine with as much potential for positive transformation as there is now. However, many of the changes in healthcare over the past few years have unfortunately been driven by the needs of government rather than those of patients or physicians. Providing adequate resources and care is becoming a scenario best summed up by the phrase: “Resources for some, some of the time”. This is hardly an acceptable arrangement – either for patients or physicians.
What needs to change? In our opinion, two things:
1) improved accountability by the Ontario Medical Association (OMA) to the physicians that it represents; and
2) the freedom to innovate and explore alternative ways of delivering healthcare in Ontario.
Obviously, these considerations transcend the concerns of family physicians alone, and are applicable to all physicians in Ontario. Allow us a few minutes of your time to explain further.
Improved accountability of the Ontario Medical Association to its members is an absolute necessity. While Ontario physicians are legally obliged to accept the OMA as its government-appointed representative body (Bill 8, the Commitment to the Future of Medicare Act, 2003), and are also obligated to pay the OMA dues (the Ontario Medical Association Dues Act, 1991), there now exists a “wait your turn” mentality when it comes to meeting the needs of various physician groups. In most other Canadian provinces, dues payable to physicians' professional associations are voluntary rather than mandatory. It is perhaps not surprising that, in the light of such built-in accountability, these provinces have fared significantly better in gaining compensation and resources for their members, while still achieving voluntary membership rates of about 95%.
Affected physicians in Ontario – whose needs remain unmet – have no recourse except to wait and hope that at some undetermined future date they will be dealt with fairly and equitably. Meanwhile, the OMA attempts to balance the interests of its members and those of government in a collaborative arrangement, in part because government assures the OMA’s ability to collect its dues. In good economic times this is an awkward predicament at best, with ill-defined or conflicting allegiances. It is expectedly a much less effective arrangement in recessionary times, as the stark new reality of deficit budgeting looms.
While continued government underfunding of healthcare undoubtedly contributes to the concerns of Ontario physicians and their patients, physicians are explicitly prevented by Bill 8 from exploring and innovating in order to create new ways of delivering and funding healthcare beyond the limited ways allowed by government. At the same time, other Canadian provinces are actively and successfully exploring sustainable alternatives – such as public-private partnerships, a two-tier approach and other creative solutions. The forced collaboration between physicians and government that was hailed as a solution to problems of sustainability in the ‘90s is now a major hindrance that prevents innovation.
Options beyond the government-mandated universal healthcare system are not discussed by the OMA, likely for fear of risking its collaborative relationship with the Ministry of Health and Long-Term Care (MOHLTC) and its attendant financial advantages. Instead, it seems to accept the current government agenda of requiring healthcare providers to bear the burden by tacitly accepting chronic underfunding and under-compensation by a cash-strapped provincial government driven by ideology rather than a realistic plan for sustainable healthcare.
So, how does this affect you?
Ontario physicians have among the lowest fees in Canada, and the present contract will do little to change this. For example, after having been without a contract for six months, the negotiated 3% top up to our fees scheduled to take effect in October, 2008 has now been pushed back to February, 2009 as a lump sum payment – again with no retroactive penalties or interest. Add to this the scheduled 3.6% increase in OMA dues in the face of a delayed 3% fee top-up, and the deal doesn’t look so good at all, does it? We would not be surprised if further unilateral changes to the present deal appear in the near future.
We must stress that the Coalition of Family Physicians of Ontario recognizes the government’s inability to provide better funding, especially at a time of fiscal contraction. However, we also view this as an especially important time for encouraging major innovation and reform of an otherwise unsustainable healthcare system. With or without the OMA, this is the direction that we have chosen to pursue and promote in 2009.
Other provinces have already taken successful steps in this direction by allowing a limited two-tier approach to healthcare delivery and funding. It is also the approach adopted by the rest of the Western industrialized nations, most of which have a more effective and equitable healthcare system than our own. Leadership in this area has also been provided at the national level by the Canadian Medical Association, which has chosen to open a dialogue on having more privately-delivered services alongside a robust public system. The past and present CMA presidents, Dr. Day from British Columbia and Dr. Ouellet from Quebec, are both influential and outspoken advocates of exploring such options.
It is time for Ontario’s representative physician body to provide leadership in this direction – away from dependency, and towards more physician and patient empowerment – rather than serving short-sighted political agendas. Unfortunately, the OMA seems to be unable or unwilling to do this because of its close ties to government. To fill this void, we are presently forming alliances with other physician groups in Ontario, who are interested in reforming our healthcare system in new and exciting ways.
The present economic situation in Ontario necessitates new ways of looking at things in order to bring about true innovations in healthcare that will provide freedom of choice and better care to more patients in the long term. The Coalition of Family Physicians of Ontario will continue to support Ontario physicians as always, and invites you to join our efforts, as we move forward toward a compassionate, reasonable and sustainable healthcare system in 2009 and beyond.
Sincerely,
Douglas Mark MD, President
and the Board of the Coalition of Family Physicians of Ontario
P.S. We’ll have more to say about our future plans, as well as sharing the details of our spring conference with our members, in the weeks ahead!
Contrary to the picture painted by the COFP, the OMA has had some complaints of its own about the provincial government's healthcare policies since the new contract was ratified in October. Last month, the OMA criticized the decision to delay funding 50 new Family Health Teams by one year as a result of the budget's shortfall. At the same time, however, the government expanded its support for nurse practitioner-led clinics. "I'm disappointed to see the provincial government's delay in implementing 50 new Family Health Teams, while at the same time, expanding the number of nurse practitioner clinics," OMA President Dr Ken Arnold said in a release. "Not only does this model serve a small group of patients, but we have not seen any solid evidence proving its ability to provide high quality, cost-effective care."
Health Minister David Caplan was annoyed at the suggestion that the government had made the move to save money. "This is not a financial decision," he told the Toronto Sun's Christina Blizzard. "It is one that provides better care and provides the kind of care that Ontarians wish to receive -- to be able to get access into the health care system -- this is another way to provide that."
