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In speech to CMA, Aglukkaq skirts reform issues

In an address to the Canadian Medical Association on Monday morning, federal health minister Leona Aglukkaq spoke about crucial topics including the radioisotope shortage, the H1N1 flu pandemic and health promotion.

But Ms Aglukkaq did not appear eager to respond to the CMA leadership's increasingly loud call for the government to implement major health-system reform and to reconsider some of the restrictions on private healthcare funding imposed by the 1984 Canada Health Act.

Considering she was appearing at a conference titled “Health Care Transformation: We Can All Do Better,” doctors in attendance might have expected that Ms Aglukkaq would make at least passing reference to the state of health policy reform in Canada. CMA president Dr Robert Ouellet even appeared to invite her to do so when he introduced her. “You join us at a time of considerable change,” Dr Ouellet said. “You are also no doubt aware of our discussions that will take place here in Saskatoon about our efforts to transform the healthcare system to put patients first.”

But, apparently mindful that her audience for this morning's speech would be reported on well beyond the walls of the downtown Saskatoon conference hall where she spoke to the nation's senior physician leaders, Ms Aglukkaq chose to focus instead in her speech on the two medical crises that have recently grabbed the public's attention.

Ms Aglukkaq spoke broadly about what is anticipated to be a significant resurgence of the pandemic H1N1 flu virus in Canada this fall and winter. She summed up the government's recent efforts to disseminate information and work with pharma company GlaxoSmithKline to produce a vaccine for this November, and she encouraged physicians to consult clinical guidelines available at (For more on the federal government's preparations for the H1N1 flu's second wave, don't miss Parkhurst Exchange's wide-ranging Q&A with the nation's chief public health officer Dr David Butler-Jones, set to appear soon in the magazine's September issue.)

At one point, perhaps forgetting she was standing in front of a room of perhaps a thousand experienced clinicians, Ms Aglukkaq decided to provide the public with some of her own medical advice: wash your hands, she said, cough into your sleeves, and stay home if you're ill.

A few minutes later, however, her faltering voice seemed to signal that she could use some clinical attention herself. “I hear there's a doctor in the house,” she joked to a smattering of polite laughter. This audience has heard that one before.

On the topic of the radioisotope shortage – which, as you will recall, is the result of unanticipated repairs that shut down the Crown-corporation-owned Chalk River nuclear facility in Ontario – Ms Aglukkaq began with a simile to demonstrate her familiarity with the subject. “As you well know, medical isotopes cannot be stockpiled,” she said. “As a result, distributing them is like delivering ice cubes from door to door on a hot summer day.”

Alternatives to the technicium-99 produced at Chalk River are now being researched, Ms Aglukkaq said, and the long-term plan is still to get Chalk River's production up and running again. (The estimated date when the plant will be producing isotopes again has been pushed back several times, most recently to spring 2010.) Another part of the long-term radioisotope solution, she said, is to better coordinate radioisotope production shutdowns with the other providers overseas, such as the ones in the Netherlands, South Africa and elsewhere. Overlapping shutdowns have proven to be problematic this summer.

During the Q&A with CMA members after Ms Aglukkaq's speech, she was asked by Canadian Society of Nuclear Medicine president Dr Christopher O'Brien whether the additional costs incurred by the provinces buying alternatively sourced radioisotopes would be covered at all by the federal government. Ms Aglukkaq replied that several provinces have raised the issue with her and that she plans to discuss the matter with the provincial health ministers at a meeting in Winnipeg next month.

Ms Aglukkaq also acknowledged the substandard health conditions seen in First Nations, Inuit and remote Canadian communities. She spoke of the need to ameliorate what are called the social determinants of health, such as education and housing, and quoted Benjamin Franklin: “An ounce of prevention is worth a pound of cure.”

Ms Aglukkaq concluded her speech – still with no mention of the Canada Health Act or health policy reform or the CMA's “transformation” agenda – by recognizing the medical community's altruism.

“Just as your decision to enter medicine wasn't based on money, neither was my decision to enter politics based on prestige or power," she said. "The determining factor in your decision was most likely the same as it was mine: the real chance to make a difference and be rewarded by the immeasurable satisfaction of saving lives and helping change lives for the better. When faced by challenges such as most people are today, it is important for us to remember this and to realize the time for this ambition is now.”

Photo: Health Canada

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