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What's in the news: Dec. 3 -- The WHO's new HIV treatment recommendations

WHO revises ART recommendations
This week, the World Health Organization issued new recommendations on anti-retroviral therapy for adult and adolescent HIV patients. The new recommendations are a major departure from what had previously been in place. For instance, the WHO is now advising that physicians begin ART when the patient is presympomatic, at a CD4 count of 350 cells per cubic milliliter rather than 200 cells per cubic milliliter. The 200 figure was included in WHO recommendations in 2006, but research over the last three years found that earlier ART showed large enough improvements in reducing morbidity to be worthwhile. [World Health Organization news release] [Medscape]

Some Canadian guidelines were ahead of the WHO's. In February 2009, the widely respected BC Centre for Excellence in HIV/AIDS recommended beginning ART before the CD4 count drops below 350 cells per cubic millileter. [BC Centre for Excellence in HIV/AIDS Therapeutic Guidelines (PDF)]

Another important aspect of the new recommendations will likely not affect Canadian patients and their doctors: the WHO would like to see the anti-retroviral Stavudine phased out and replaced by drugs that cause fewer and less severe side effects. Stavudine is mainly used in the developing world. [Reuters] [Nature blog: The Great Beyond] Zidovudine and Tenofovir are suggested as replacements for first-line therapy.

The new WHO recommendations also say that mother-to-infant disease transmission is best avoided by full-course ART rather than single-dose treatment. That recommendation was met with praise by the international AIDS Healthcare Foundation, which was eager to take credit for helping to push the WHO to make changes. [AIDS Healthcare Foundation news release]

New efforts to repair humanitarian drugs law
The federal parliament is considering a private member's bill that would reform the largely failed Canada's Access to Medicines Regime, which is intended to encourage Canadian pharmaceutical companies to provide low-cost drugs to African nations. The system as it currently exists has only been used once in five years when Rwanda purchased cheap anti-retroviral drugs. Bill C-393 was proposed by NDP health critic Judy Wasylycia-Leis. [Bill C-393]

Paul Martin, Dr James Orbinski, David Suzuki and other prominent Canadians signed an open letter circulated by the Canadian HIV/AIDS Legal Network asking the government to repair CAMR. [Canadian HIV/AIDS Legal Network] [Toronto Star]

The bill passed second reading on Wednesday afternoon, with 143 MPs in favour and 127 against. More than a dozen Conservative MPs joined with the Bloc, NDP and the majority of the Liberal caucus to pass the bill on second reading. Health Minister Leona Aglukkaq voted no, as did Liberal Keith Martin, a former physician who has done extensive humanitarian work in Africa and in the field of international development. The bill will now be studied by the House committee on industry, science and technology before a final vote.

During the last discussion of the bill, at the end of November, several Conservative members explained their opposition. Bill C-393 "could have serious negative implications for continued pharmaceutical investment and growth in Canada," said Mike Lake, the parliamentary secretary to the minister of industry.

MDs accused of slowing progress on licensing foreign-trained docs
The latest development is that, in 2013, provincial medical regulatory bodies will be required by the government to assess the credentials of foreign-trained physicians within 12 months. But a number of other professions, including nurses and pharmacists, will do the same thing two years sooner.

"There are some of the major professional agencies -- let's make no bones about this -- who are less willing to co-operate, less willing to streamline the process and cut the red tape and reduce the processing time," said Immigration Minister Jason Kenney. Mr Kenney named physicians as one of those less cooperative groups, but no other professions. [Ottawa Citizen] [Toronto Star]

The Canadian Medical Association immediately took issue with Mr Kenney's criticism, saying, "The medical profession has not been dragging its feet on the issue of foreign credentials - far from it. Medicine has had a national standard for licensure since 1992. It is currently about to pilot test a national assessment for international medical graduates [IMGs] and a national credential verification system has also been developed." [CMA news release]

"[Until 2013 is] still a long time to wait, and there's a nasty backlog to clear up, but all the same this is a substantial accomplishment," wrote the Montreal Gazette in an editorial. "Things take time. As NDP MP Olivia Chow noted, better credential-verification for doctors will be of little use unless more intern positions are opened up. That's one example of what needs to be accomplished in the next couple of years if this reform is to be fully fruitful." [Montreal Gazette]

Many suspected H1N1 flu cases are just colds
Up to 75% of patients believed to be infected with the H1N1 flu may actually just have a cold. Lab test in Ontario found that fewer than one in four suspected H1N1 flu cases were actually the flu, and similar tests in BC yielded a figure of one in three.

"We have been notoriously inaccurate," Dr Michael Gardam, of Ontario's Agency for Health Protection and Promotion, told The Globe and Mail. "This year is very different because we are swabbing way more than we ever would and we are more accurate than we've ever been before – and it's still not very accurate." [Globe and Mail]

Ontario permits naturopaths to prescribe drugs
Follows the lead of some American states and British Columbia, Ontario legislators passed a bill earlier this week that will permit naturopaths to prescribe some substances. [Bill 179]

Which drugs they will be allowed to prescribe has not yet been determined, but a representative of the Ontario Association of Naturopathic Doctors (OAND) said that the organization hopes the government will follow the recommendations set out by the Health Professions Regulatory Advisory Council in a report in January 2009. Their list includes some hormones, natural enzymes, antibiotics, antifungals, one antiviral and several medicated topical creams. [HPRAC Critical Links report (PDF; see pp. 265-268)]

But Dr Suzanna Strasberg, the president of the Ontario Medical Association, told the Canadian Medical Association Journal last month, "We believe that the use of pharmaceuticals or synthetic drugs is completely outside naturopathy’s educational framework and scope of practice." [CMAJ (PDF)]

"We're not looking to take over the role of MDs," OAND policy director Michael Heitshu told Canadian Medicine. "Because a typical ND appointmen is 40 to 60 minutes, we have more time in the diagnostic process and can establish the kind of patient relationship that can find the causes of diseases and work on compliance issues."

Bill 179 has stirred up a great deal of controversy, particularly among opinion columnists and bloggers, but it is now law and all that remains is to see what exactly the Ontario government will grant naturopaths the authority to prescribe.

Astro-doc Robert Thirsk is back on earth
Dr Robert Thirsk, the physician-cum-astronaut who just spent the last six months living on the International Space Station, has returned to the surface of this planet.

"The end of my Station sojourn is bittersweet. I will miss the challenge of living in space," wrote Dr Thirsk from the ISS before his departure. "On every day of this expedition, some task has pushed my capabilities to a limit. Most of all, I will miss my wonderful crewmates. We had a special synergy." [Canadian Space Agency]

Dr Thirsk landed safely in Kazakhstan in a Russian capsule on Tuesday. [Canadian Space Agency]

Fibre consumption linked to healthy weight
Protein, fat and carbohydrate consumption are not directly tied to obesity. But eating more calories and eating less fibre are. That's according to data from the Canadian Community Health Survey. [Globe and Mail]

U de M researchers forced to rethink porn study
University of Montreal researchers were forced to change the research project they originally set out to do -- to compare porn-watching men to non-porn-watching men -- when they discovered that the latter did not seem to exist. [The Sun (UK) (This link contains fairly explicit sexual imagery)]

Tory MP praises scarcity of Saskatoon abortion services
After news broke last month that Saskatoon women were forced to leave the city to find a physician to perform abortions, Conservative MP Maurice Vellacott, who is the co-chair of the House of Commons' Pro-Life Caucus, announced he was proud that local doctors had reduced the availability of abortion services in the city. Toronto Star columnist Antonia Zerbisias takes him to task and bemoans the fact that neither the Prime Minister nor his minister of state for the status of women were willing to speak out against Mr Vellacott. [Toronto Star]

New Brunswicker sees surfeit of Canadian doctors in future
After reading the recent news that the number of doctors in Canada grew faster than did the population over the last five years, Fredericton Daily Gleaner columnist Jo-Ann Fellows wrote a piece titled "Canada is heading towards an oversupply of physicians." [Fredericton Daily Gleaner]

Ms Fellows's column is an ominous reminder of the same kind of dangerous thinking that brought us the infamous 1991 Barer-Stoddard report [Toward Integrated Medical Resource Policies for Canada (PDF)] that led to governments' disastrous decisions in the 90s to reduce the number of training spots available for medical students and interns.

For a more in-depth look at how many doctors Canada will have in the future, you may want to look at this 2007 Canadian Medical Association analysis, which includes a number of different projections based on various factors. [Projections of Physician Supply in Canada (PDF)]

Vancouver MD dies in plane crash
Dr Kerry Telford, her six-month-old daughter, and four other people were killed when a float plane they were on crashed into the water near Saturna Island, BC. [Vancouver Sun]

What really really killed Jane Austen?
It wasn't Addison's disease -- it was tuberculosis that she caught from a cow. So says a new explanation published in the British journal Medical Humanities. [Medical Humanities abstract] [The Guardian (UK)] In February 2008, Canadian Medicine asked you, our readers, what you thought killed Ms Austen. Addison's disease came in first in our poll; Hodgkin's second. Tuberculosis was tied for 9th in our poll, tied with syphilis, out of 12 options. Writer's cramp got more votes than tuberculosis. [Canadian Medicine]

Photo: World Health Organization

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  1. tagskie3 December, 2009 3:00 AM

    hi.. just dropping by here... have a nice day!

  2. sharon3 December, 2009 11:14 PM

    I originally met Maurice Vellacott in the 1970's before he became a politician.
    I was tremendously impressed with his capacity to endure and sustain a high standard in the midst of extreme opposition.

    Occasionally you can refer to someone as a " a man among men".... one who is the equal of or an example to all others .......

    Maurice Vellacott is one of these .......

  3. Sam Solomon4 December, 2009 1:07 PM

    In all fairness to Mr. Vellacott, his position on abortion is more nuanced than just disapproval, as the short item above might imply.

    This is what he told me in January 2008, in commemoration of the 25th anniversary of the Morgentaler decision:

    "For pro-lifers, there was actually a positive element to the Morgentaler decision. But you'd never know it, given how the decision has been twisted and misrepresented by radical abortion activists and many in the media, and even in the medical and legal professions, for almost 20 years now. And this is tragic, because in that decision, the Supreme Court unanimously declared that Parliament has a responsibility to create a new law to protect the unborn child - a new law which would not have the constitutional problems inherent in the previous law. Canada grades an 'incomplete' on that Supreme Court assignment."

  4. sharon4 December, 2009 4:42 PM

    Very interesting interviews, Sam

    For those who view humans as "fully human" at conception ,and have reverence for life at all stages, I find a contradiction that is rarely spoken about ...if ever... in public.

    The contradiction is based on the reality that Morgentaler is of Jewish heritage.. a race terribly traumatized by killing in the holocaust.

    If the killing of human life, or the facilitation of that killing, is viewed as relevant...we have in Morgentaler the perpetrator of a holocaust in even greater numbers of lives lost.

    Is not Morgentaler of Jewish descent?

    The contradiction of horror for destruction of one's race specifically by another identifiable race...and celebration of another similar but opposite direction......

    .... is horrific in it's dimensions on both accounts...

    I too, have seen the horrors of planned abortion behind closed medical doors...and it is not the neatly packaged outcome that is presented on paper :(.

  5. Sam Solomon4 December, 2009 5:24 PM

    I think there's a reason that supposed contradiction is rarely spoken of, Sharon.

    I've never been able to grasp the abortion/Holocaust moral-equivalency argument, and I think there's a reason for that: it's a specious one, and one that fails to do justice to either subject. Of course, I get that for people who believe that life begins at conception, abortion is murder. But that doesn't mean it's anything remotely similar to genocide. There shouldn't be much explanation required on this point to demonstrate why.

    I've always been of the opinion that there are much more fruitful, and less distracting, ways to debate the issue. Fortunately, for the most part, anti-choice activists tend to avoid the comparison.

  6. sharon4 December, 2009 6:49 PM

    Abortion and genocide are on the same line for me... however I do not believe in " issues" advocacy to effect change.

    Systemic advocacy is harder, takes longer, and gives a bigger result.

    It is not for the faint... but for those adroit at "feint".... that victory comes.

  7. sharon6 December, 2009 10:42 AM

    RE: Invention, production and distribution channels for drugs in ? humanitarian perspectives:

    This documentary should be watched:

    (a) impact of cheap alternatives containing inadequate amounts of the curative substance has permitted malaria to mutate into stronger resistance

    (b)the mosquito bearing the stronger drug resistant parasite is showing up farther afield than expected.

    You might say this event is ?third-world with no inroads into North America.

    Let me share this personal experience:

    I was doing research on a service model which involved being seated at a dinner table as a visitor with a group who were friends to each other.
    One was a legal consultant developing an ethics program for a prison.
    One was very successful entrepreneur in the construction industry.
    One was a North American person producing prescription drugs offshore.

    I was pleased that my relationship with these people would be very brief.

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