"Clooney taught us"
Dr Peter Brindley's critical care medical students at the University of Alberta were consistently doing intubations wrong. It turns out it's the television drama ER's fault, reported Dr Brindley in the journal Resuscitation earlier this month. He watched the fictional MDs doing intubations and, indeed, they did them incorrectly in many instances. [National Post] But one reader took issue with med students blaming their mistakes on TV: "Holding ER liable for medical students practising incorrect medical procedures is akin to blaming gun violence on video game developers." [National Post]
Manitoba floods spark water worries
With major flooding set to hit Manitoba, the province's chief medical health officer, Dr Joel Kettner, warned residents that the flooding may contaminate water from wells, and recommended boiling well water before consuming it. [Canadian Press]
Death by "excited delirium"
Trevor Grimolfson, who died after he was shot with a Taser during an altercation with police in October in Edmonton, died of "excited delirium" and not because he was shot by the Taser, an Alberta medical examiner concluded. [Edmonton Journal] "Excited delirium" is not a medically recognized condition or diagnosis. It's a controversial term often used by police departments to "whitewash" the deaths of people in custody, the American Civil Liberties Union has said. [National Review of Medicine]
Meanwhile, Quebec has asked police officers to return some of their Taser guns to laboratories for testing after a CBC investigation found that some guns fired higher voltages than they were supposed to. [CBC News]
Rolling the dice
The Calgary Herald speculated that the recession could lead to a rise in the social and health costs of gambling. [Calgary Herald] In related news, a University of Calgary psychology PhD candidate has begun recruiting subjects for a study on the stigma of gambling addiction. [University of Calgary UTODAY]
Where's the weed?
Federal Health Minister Leona Aglukkaq said this week that her department will study potential restrictions on where licensed users of medical marijuana are allowed to smoke. [Canwest News Service]
A coughing fit
A consumer-rights group in Quebec filed an $8-million class-action false advertising lawsuit against the producers of children's cough and cold medicines. The group, Option consommateurs, alleges that eight major drug companies intentionally misled consumers into believing that the drugs would be effective. [Montreal Gazette]
Canadians on drugs
A new report on Canadians' prescription drug consumption habits showed that total sales rose nearly 6% in 2008 to $21.4 billion, and that generic drugs now account for more than 50% of that figure. [Canadian Generic Pharmaceutical Association news release] The number of prescriptions filled in 2008 amounts to an average of 14 per Canadian. [Globe and Mail]
"Is there a doctor on board?"
The number of medical emergencies on airplanes is on the rise. A representative of a company that handles emergency calls from airplanes said that the two most common injuries are those caused by the beverage and food carts pushed down the aisles and those caused by bags falling out of the overhead compartments. [Toronto Star] In 2007 I wrote about Canadian doctors' complaints that airlines weren't giving them the resources they needed to help patients in the air. [National Review of Medicine]
Too sweet or not sweet enough?
McMaster University researchers were among those who published a study in yesterday's New England Journal of Medicine that showed that -- contrary to what had been assumed -- attempting to bring down the blood sugar levels of patients in intensive care can be more harmful than leaving them at elevated levels. [NEJM abstract] [NEJM editorial abstract] [McMaster Daily News]
K.I.S.S. with hypertension
Simplifying recommendations for family doctors on how to treat patients' hypertension results in better patient outcomes, report University of Western Ontario researchers in the April issue of Hypertension. [Hypertension abstract]
"The nature of hypertension management has changed," said Dr Ross Feldman, who led the study. "It’s much more aggressive, and complex, leading to hundreds of recommendations on how to manage high blood pressure... This should be a call to hypertensive patients to go to their family physicians to be prescribed these single pill combinations. It makes both the patients' and doctors' lives easier." [Western News]
More news from across Canada and beyond
Manitoba MP Stephen Fletcher was denied the chance to appeal to the Supreme Court a lower court's decision that the Manitoba public health insurance system was not required to pay him more than its $3,000/month stipend for medical assistance. Mr Fletcher was paralyzed from the neck down when his car hit a moose in 1996. [Globe and Mail]
The Canadian Centre for Policy Alternatives is publishing a blog about the rapidly approaching provincial election in British Columbia. [The Lead-Up] You can read all the healthcare-related articles by clicking here.
The Canadian Medical Association has started a series of podcasts on the theme of physician wellness. The first episode, called "The many layers of the healthy
doc," "explores the fine balance between self-awareness, collegiality within the profession and being a healthy physician." [CMA news release]
What's it like to be the White House physician? [American Medical News]
Republicans are healthier than Democrats, according to a new study. [International Journal of Epidemiology abstract] Why? "The authors hypothesize that the better health reported by Republicans may reflect the Republican value of individual responsibility, which may lead to health-promoting behaviors. They also note that Republicans may exhibit greater religiosity than Democrats, which could lead to greater health-promoting conditions, such as stronger social ties and networks." Maybe. [Harvard School of Public Health news release]
The US Association of Health Care Journalists announced their 2008 award winners. [AHCJ]
More on the Canadian-healthcare-killed-Natasha-Richardson story, this time from a physician writing in the New York Post under the all-capitals headline "CANADACARE MAY HAVE KILLED NATASHA." [New York Post]
Latest headlines
Friday, March 27, 2009
What's in the news: Mar. 27 -- George Clooney's corrupting influence
Wednesday, March 25, 2009
What's in the news: Mar. 25 -- Saskatchewan's infant-HIV problem
Saskatchewan's "AIDS crisis"
Nearly one in four HIV-positive infants born in Canada from 2005 to 2007 were born in Saskatchewan, setting off concerns among Saskatchewan public health and obstetrics experts. [CBC News]
Reacting to the news, the Regina Leader-Post wrote, "Saskatchewan has an AIDS crisis." [Regina Leader-Post]
Dr Moira McKinnon, the province's chief medical officer, is studying the reasons for the disproportionate number of HIV-positive births. She suggested that drug users and sex workers need more attention paid to their health. [CBC News]
How do you solve a problem like obesity?
Obesity, declared Dr Arya Sharma, is not a lifestyle choice. Calling for an expansion of the investment of funding and effort into obesity, Dr Sharma, who's a professor and practitioner in Edmonton and the scientific director of the Canadian Obesity Network, wrote in a Globe and Mail commentary that "too many health professionals also do not understand obesity; they offer advice that is useless, expect the impossible from their patients, fail to acknowledge root causes, or ignore the barriers to treatment." [Globe and Mail]
Quebec's third party regroups
The ADQ party, which lost its official opposition status and its longtime leader, Mario Dumont, in last year's election, is in the process of selecting a new leader. The first person to announce his candidacy is the party's experienced MNA and health critic, Eric Caire, who has for years assailed the Liberal government's health ministers Philippe Couillard and Yves Bolduc on their reluctance to expand privatization options in the healthcare sector. [Montreal Gazette] [Montreal Gazette]
Come clean
Montreal family physician Marie-Dominique Beaulieu warned that family secrets are detrimental to one's health. Also: did you know the woman Jack Nicholson believed to be his mother turned out to be his sister, and he learned about it from a newspaper article? Bizarre. [Université de Montréal news (French only)] [UdeM news release]
Backseat doctoring
The Natasha-Richardson's-death blame game continues online, at M.D.O.D. (at fault: socialized healthcare... or -- oops -- maybe not), Pure Pedantry (at fault: Richardson, for declining immediate medical attention... but really at fault: poor patient education about head trauma), and NHS Blog Doctor (at fault: the "wussification" of doctors, by which he means defensive medicine and an over-reliance on technology).
Grand Rounds
The weekly collection of health bloggers' best articles was published at a nursing blog this week. [Code Blog]
Friday, March 20, 2009
What's in the news: Mar. 20 -- A quick round-up
Today, an abbreviated version of our regular "What's in the news" feature with a round-up of recent health news from across the country.
The government of British Columbia has filed a countersuit against former Canadian Medical Association president Dr Brian Day and other private clinic owners, alleging the private clinics have been using illegal billing practices. [Vancouver Sun] [Vancouver Sun] The Canadian Health Coalition has made available several legal documents related to the case, here and here (both PDFs). The clinic owners' lawsuit, filed in late January, argues that the province's restrictions on private clinics violate patients' constitutional rights. [Canadian Medicine]
Foreign-trained doctors demand an inquiry into Quebec's medical residency system to determine why so many international medical graduates were not assigned residencies. [Montreal Gazette]
A provocative American blogger wondered out loud whether the Canadian healthcare system might be at fault in the death of actress Natasha Richardson, who fell and hit her head while skiing at Mont Tremblant. [Kennedy's Tumor] Dr Kevin Pho answered: probably not. [KevinMD]
Being shot in the head by a Taser can cause a seizure, a group of Ontario researchers reported in a case report in the Canadian Medical Association Journal. [CMAJ] [CTV News]
A Montreal nurse and three other aid workers kidnapped in Darfur were freed in short order. [Montreal Gazette] [Voice of America]
A Cooksville, Ontario, tattoo parlor named Moonshin Tattoo is at the centre of a public health investigation into the potential spread of HIV and hepatitis C because of sterilization problems. A $20 million class-action lawsuit has been launched. [Mississauga News] [Sudbury Star]
To accompany a new marketing campaign to encourage patients to report adverse events they experience from medications, Health Canada has issued a brief new guide for health professionals on when and how to report adverse events through the MedEffect system. [Health Canada]
Recommending that Canadians eat two servings of fish per week, as Canada's Food Guide does, is a bad idea, some researchers and environmentalists said. Eating so much fish may be unsustainable and has uncertain public health benefits. [Globe and Mail]
The city of Calgary set new regulations on the content of trans fat that foods served in restaurants could contain, but the new provincial Alberta Health Services board has reversed that policy and eliminated the regulations. [CTV News] [CBC News]
The federal Minister of State for Science and Technology, Gary Goodyear, refused to answer questions about whether he believed in evolution or not. "I am a Christian, and I don't think anybody asking a question about my religion is appropriate." [Globe and Mail] Mr Goodyear is a chiropractor, which some in the medical profession might believe to be even less scientific than creationism.
Ontario Government Services Minister Ted McMeekin wrote to Health Canada to ask for clarification on where licenced users of medical marijuana are permitted to smoke. Current regulations don't specify. [Canwest News Service]
Ontario issued more medical licences last year than it has in any year since 1985. [Canadian Press]
The majority of McGill medical school graduates elect to leave the province to find work. Dr Gilles Aubé, who ran for the Parti Québécois in the last election, has suggested getting students to sign a return-of-services contract to keep them in Quebec for at least a little while. [Toronto Star]
Alberta's doctors are behaving themselves: for the third year running, the number of complaints filed against them dropped. [Canadian Press] [Edmonton Journal]
Elliot Rappaport, a Montreal ex-doctor who lost his licence to practise in 2002, was charged with two charges each of sexual assault and forcible confinement for allegedly tying up female patients, using a blindfold and a gag, and touching them. In 1995, when similar complaints were levied against him, he claimed it was a medical technique. At the time he was suspended for one year but allowed to return to practice thereafter. The Quebec College of Physicians and Surgeons refused to make public the reason he lost his licence in 2002. [Montreal Gazette]
Former Quebec health minister Philippe Couillard's surprisingly fast jump from the National Assembly to a private health-sector investment firm last year did not violate any lobbying laws, a review found. [Montreal Gazette]
Dr Mehmet Oz -- of Oprah fame -- wrote that the drama ER was his "my other med school." "Our mirror neurons fired away as we identified with George Clooney’s Dr. Doug Ross and Julianna Margulies’ Carol Hathaway exorcising their demons." [The Daily Beast]
The Pope, whose advice on prophylaxis one is loathe to trust, said that condoms cannot stop the spread of HIV. "On the contrary," he said, "it increases the problem." [CBC News]
The health bloggers' Grand Rounds is online. [ACP Internist]
And the health policy bloggers' Health Wonk Review is online, too. [HealthBlawg]
Michael Jackson may have expressed interest in having his body plastinated for public display by the doctor and anatomist Gunther von Hagens after he dies. [Der Spiegel] I interviewed the rather strange Dr von Hagens when his Body Worlds exhibit came through Montreal in 2007. [National Review of Medicine]
Will Canada's next astronaut be an MD?
The medical profession is well represented among the 16 remaining candidates in the Canadian Space Agency's unusual Survivor-like process to select Canada's next two astronauts, with two MDs and one med student still in the hunt.
The 16 candidates -- winnowed down from 5,351 applicants via a series of physical and skill tests (check out the photos) -- were introduced earlier this week. In addition to one microbiologist, one zoologist, and all the engineers and physicists, who dominate the list, the CSA chose Drs Christopher Denny and David Saint-Jacques, as well as med student Keith Wilson.
Here's what the CSA's bios say about each of them:
Christopher Denny
Born and raised: Toronto, ON
Current residence: Toronto, ON
Education:
-BA, Queen's University (1994)
-MD, McMaster University (1998)
-MSc, Clinical Epidemiology, University of Toronto (2004)
Christopher currently works as a Staff Physician and Trauma Team Leader in Emergency Medicine at the Sunnybrook Health Sciences Centre. He is also a Base Hospital Physician for Toronto Emergency Medical Services, a Transport Physician for Ornge Transport Medicine and a Team Physician for Toronto's Heavy Urban Search and Rescue Team. He also works as an Assistant Professor in the Department of Medicine at the University of Toronto.
David Saint-Jacques
Born: Québec, QC
Raised: Saint-Lambert, QC
Current residence: Montreal, QC and Puvirnituq, QC
Education:
-BEng, Engineering Physics, École polytechnique de Montréal (1993)
-PhD, Astrophysics, Cambridge University, UK (1998)
-MD, Université Laval (2005)
David is currently a medical doctor practicing at Inuulitsivik Health Centre in Puvirnituq, Northern Quebec. He also works as a Clinical Faculty Lecturer at McGill University's Faculty of Medicine.
Keith Wilson
Born and raised: Winnipeg, MB
Current residence: Winnipeg, MB
Education:
-BA, Commerce, Royal Military College (1992)
-BSc, General, University of Waterloo (2007)
-MD, University of Manitoba (ongoing)
Keith is currently a medical student at the University of Manitoba. His career with the Canadian Forces included 14 years as a military Search and Rescue helicopter pilot and test pilot. While with the military, he also worked at the Aerospace Engineering Test Establishment, where he most recently was responsible for the coordination, conduct and efficiency of AETE air operations.
To decide amongst the 16, the CSA plans to conduct interviews with all the remaining candidates and subject them to medical tests.
The two selected to join the agency will be named in May, which happens to be the same month that Dr Bob Thirsk, a Canadian physician and astronaut, will blast off from Russia to join the crew of the International Space Station for a six-month stay, making him the first Canadian to live in space for an extended period of time.
Keep your eyes on Canadian Medicine over the next month or two for a Q&A with Dr Thirsk.
Wednesday, March 18, 2009
MDs warming to environmentalism
In this month's issue of Parkhurst Exchange magazine, I have an article about the ten-fold rise in membership that the Canadian Association of Physicians for the Environment has seen in just the last two years, going from 400 members in September 2006 to over 4,000 today.
"It's been an exciting time for us," said executive director Gideon Forman. "We think it's a very exciting development that doctors are playing a leadership role in the environmental movement,” he said. “Docs are trusted so much by the public, and they have huge credibility with policy-makers. We have access to decision-makers that other groups don’t.”What sparked the group's sudden popularity? Read the rest of the article here.
The medical profession’s interest in environmentalism is relatively recent, said Mr. Forman. Though CAPE’s membership grew 10-fold in the last two and a half years, it didn’t attract a great deal of doctors’ involvement in its previous 13 years.
Tuesday, March 17, 2009
Can Canadian doctors fire their patients?
In short: yes.
It's not easy. Doctors have to avoid violating ethics guidelines, regulatory policies and even human rights laws. But if a doctor is inundated with patients, then firing patients is permitted.
Several cases have already come up in which doctors have fired hundreds of patients en masse, using a lottery to determine which ones get cut and which ones get care. That's not the most ethical way of doing things, experts say, but with family doctors under perpetual pressure to accept more and more and more patients, this sort of situation is not likely to disappear. "The challenge from an ethical standpoint is how to decide which patients to discontinue," said Dr Jeff Blackmer, the executive director Canadian Medical Association's office of ethics. "It’s not clear-cut how to decide that."
To read my full article on how Canadian doctors can fire their patients, click here to visit the Parkhurst Exchange website.
What do you think of this practice? Should regulatory bodies forbid doctors from firing patients? Should it be made simpler, so as not to overburden doctors?
Friday, March 13, 2009
Innovative new website warns of weather's effects on health
A new website created by a Canadian doctor promises to warn patients by email of potentially dangerous interactions between their medical conditions and the weather, but the science behind the innovative idea may not be as well-established as advertised.
The site, MediClim.com, opened for business in early January. Patients who register to use its services receive email alerts tailored to specific medical conditions, such as asthma or migraines, based on the site’s twice-daily calculations of weather patterns across Canada. In just over two months, more than 5,000 users have signed up for the alerts.
Created by Toronto family physician John Bart and Environment Canada meteorologist Denis Bourque after years of study and original research, MediClim is a first in Canada. While existing provincial public-health projects do warn patients of weather conditions that could exacerbate their medical conditions, those projects have so far largely been limited to smog warnings disseminated to the general population via the media. A system like MediClim’s that allows personalized warnings -- if they can be shown to be based on statistically sound weather-to-health correlations -- is something of a holy grail in environmental public health. But that’s a big if and questions have been raised about the validity of the science behind MediClim’s claims.
DEVELOPING A THEORY
This year’s launch is the culmination of what has not been an easy process: MediClim was 24 years in the making. The idea arose when Dr Bart saw a new patient at his office named Denis Bourque, who is a meteorologist with Environment Canada. “We were just yakking,” recalls Dr Bart. “I told him, ‘You know, you’re a weatherman. I think that the weather affects my patients because I seem to get them in clumps.’” Mr Bourque called a few days later. “You’re right,” he told Dr Bart. “There is a ton of information on the subject.”
The two of them began reading the literature on biometeorology, the study of the effects weather has on health. Eventually, in 1996, based on European research, they designed their own mathematical algorithm to describe the properties of the weather -- the MediClim Index, they called it -- that they theorized would allow them to model the connection between certain weather conditions and specific medical conditions. Their research efforts, however, ran into a chicken-or-egg dilemma. “We tried to ask the federal government to take over the program,” says Dr Bart. “They weren’t interested and nobody else was either because it was statistically unproven.”
“We tried every which way to get money to do the research,” Dr Bart says. “We got some money but because I’m a GP we couldn’t get much.” Nearly 10 years after Dr Bart and Mr Bourque created the MediClim Index, they finally received some funding to put it to the test, through a federal government grant to study the connection between the environment and human health. Their work was supported by a team of researchers including Gordon McBean, a University of Western Ontario geography and political science professor who was the lead author of the 1990 and 1995 assessment reports issued by the Intergovernmental Panel on Climate Change, the organization that shared the 2007 Nobel Peace Prize with Al Gore.
Dr Bart, who has a family practice, attended research meetings and decided, with the help of another physician, what medical information the study should collect -- all in his spare time. “I’ve been carrying this idea, this understanding, for so long now that when the opportunity arose, I just couldn’t pass it up,” he explains. “I just made the time.”
The 18-month-long study tested the MediClim Index by measuring its correlation with emergency department admissions at five Ontario hospitals. The 14 weather conditions in the Index’s formula -- temperature, pressure, humidity, wind, etc. -- didn’t correlate with emergency admissions individually, but when the data was run through the Index and amalgamated, the results were encouraging: “We proved that MediClim showed statistical relationships with [emergency department] appearances at four out of the five hospitals,” says Dr Bart. The results were presented on a poster at the 2007 Canadian Meteorological and Oceanographic Society meeting but have not been published in a peer-reviewed journal.
From that research, the new MediClim.com website eventually emerged. Once again, though, funding problems arose. Pharmaceutical companies and other private-sector investors didn’t bite when Dr Bart pitched the idea to them. “And so Denis and I floated the money ourselves,” he says. “We’re tens of thousands of dollars out of pocket and, let me tell you, our wives are very understanding.”
The site opened at the beginning of January, becoming the first service of its kind available to the Canadian public. What makes it unique is that, as opposed to existing public health warning systems like the provinces’ smog alerts, MediClim issues personalized health warnings to patients with five medical conditions: migraine, arthritis, asthma, cardiovascular disease, and diabetes. A patient can go to www.mediclim.com and register anonymously by entering her medical condition, her email address and her postal code, and the website will automatically notify her by email when an air mass is approaching that is correlated with exacerbations of her condition.
The site, which also features a blog by Dr Bart and message boards for users, has ambitious plans to solicit advertisements and expand. It’s already also available in the US, the UK and Ireland, and versions are in the works for France and Spain. Another future addition will enable users to report the symptoms they experience at a given time and location, to give MediClim a giant store of data to analyze to see if any weather-health trends emerge for medical conditions they haven’t studied yet, such as fibromyalgia, allergies and Alzheimer’s.
The January launch was a success. Within just one week, without any marketing or even a public announcement, the site registered 1,300 visits and 500 people signed up to receive email alerts. “We were quite surprised,” says Dr Bart. “We ring true with patients.” By March, the number of registered users had increased ten-fold.
QUESTIONING THE EVIDENCE
MediClim has already achieved a fair amount of popularity among patients, but there remains some uncertainty about the strength of the research that the site is built upon. That doubt persists even for Dr Bart, to some extent, despite his confidence about the basic premise of the research. “Maybe our index isn’t perfect,” he hedges. “I would be really happy for someone to come along and improve it. All I want is interest. Once we get the interest everything else will follow, and the subject of biometeorology will attain its position in public health where it should be.”
Less confident is Dr Pierre Gosselin, a physician who studies the effects of weather and climate change on human health at the National Public Health Institute of Quebec and at Laval University. “I do think it is a valid hypothesis,” he prefaces his opinion of MediClim. “I like it, personally.” But to Dr Gosselin, who is also the director of the World Health Organization Collaborating Centre for Environmental and Occupational Health Impact Assessment and Surveillance, none of the research performed so far on weather-heath interactions -- much of it has come from Europe so far -- has been particularly convincing from a clinical standpoint. “The strength of the evidence is rather weak, I would say. So it’s not that science cannot be helpful, but the scientific background is relatively nonexistent or really weak in terms of being what normally is used as standards for clinical practice nowadays.” (Dr Gosselin was invited to participate in the federally funded MediClim study but declined due to time constraints.)
Most of the existing research on the subject does not meet the rigorous standards that epidemiologists demand in order to make clinical recommendations. The same goes for the MediClim research, which was not been published in a peer-reviewed journal and was only presented at a meteorology conference, says Dr Gosselin. “That is not place where lots of doctors attend at that kind of association, so you cannot expect criticism on your work on epidemiology at a meteorological meeting, so that is not strong support.”
He doesn’t doubt that some of the correlations might be true. “We will probably find some existing relationships [between health and weather] and will prove them, that is for sure,” says Dr Gosselin. “But exactly what? We don’t know yet.”
Dr Gosselin’s concerns are tempered by a belief that the site may be providing a valuable service for some patients. “That’s possible that people could be misled, but it’s the same in many other areas of medical practice,” he says. “I mean, about half of what we do is art. So let’s say I would classify this website on the art side of medicine rather than on the science side.”
FROM THEORY TO PRACTICE
A major unanswered question about MediClim is what the site’s users and their family physicians are supposed to do with the information that arrives in their email inboxes.
Dr Bart is aware of that conundrum. When the site opened in January, he asked a colleague, Dr Jon Gladstone, a Toronto migraine specialist, his opinion of it. “His email said, ‘Very nice, John. What do I do with the information when they come in and ask me about it?’ At which point I said, ‘I refer to you. I take your advice.’” Dr Gladstone was kidding around, Dr Bart hastens to explain, but there’s a chasm between the MediClim warning and what family doctors can do for patients worried about weather-health interactions.
“We hope to invite the medical community, when they are approached by their patients, to follow this,” says Dr Bart. “If you have migraines, what we’d like the physicians to say is, ‘This is one of the triggers and now be careful of all the other triggers, like don’t drink red wine, don’t book yourself a really heavy day,’ stuff like that, and maybe we can avoid people turning up in the emergency department.”
Dr Gosselin worries that patients who receive warnings from MediClim might expect something from her family doctor that the medical profession can’t really provide yet.
Part of the problem is that biometeorology is a relatively new and underdeveloped field of study. Dr Gosselin cites a recent example: his department is currently conducting research on what effects high temperatures have on prescription drugs. “The science behind it is far from being foolproof, and when you check a little more deeply you realize not much is known actually,” he says. “And you cannot make a strong recommendation to family doctors to reduce, modify or change the drug that is prescribed. Can we be more specific about who is at risk and who is not? But we cannot at this time for most prescription drugs...” He chuckles. “So nobody knows actually.”
“Very often we refer to the easy ‘Go see your doctor,’” he said about the problem in a separate interview with Canadian Medicine last year. “The poor doctor very often doesn’t know what to do exactly.”
PERSONALIZED MEDICINE
Despite his reservations, Dr Gosselin is enthusiastic about one aspect of MediClim. “The concept of a personalized warning system is a major improvement on the general public [warnings],” he says. In fact, the National Public Health Institute of Quebec (INSPQ), where he works, has a similar program of its own, funded by the federal and provincial health ministries. Using data from what’s known as the Air Quality Health Index, the INSPQ set up an automated telephone messaging service to notify employees with respiratory conditions of potentially harmful weather, with different messages delivered depending on the severity of the employees’ problems. The INSPQ is now in the process of making their system available to Quebec City residents this spring, and then potentially expanding it to other cities in the province.
The idea of a competing project doesn’t faze Dr Bart. “I am so keen to get this idea started,” he says. “I have no doubt that smarter guys than me will do a better job than me. I don’t care. I just want to get this idea out that we are not homeostatic, as we thought, without costs to us maintaining it.”
Dr Bart’s hope -- both by forging ahead with his warning system and by asking MediClim users to submit subjective weather-health data in the future -- is to provide the basis for future biometeorology researchers to improve on his work. “I just want to give them the raw material to go ahead and do it. I want to die happy one day and know that a certain amount of public health information is backed up by some research by guys who are coming out of medical school when I am in my dotage.”
The site has attracted interest from the lay media and from bloggers. It has also received a warm reception from some influential figures in the field of environmental health.
Dr Warren Bell, a former president of the Canadian Association of Physicians for the Environment (CAPE) who practises family medicine in Salmon Arm, BC, and sits on the CAPE board, was impressed by MediClim’s innovation. “I certainly know of no other service that supplies that info,” he says, though he expressed concerns about the site’s interest in accepting advertising.
“I think it’s an intriguing concept,” says Gideon Forman, the executive director of CAPE. He dismissed concerns about insufficiently solid research, saying that the site’s warnings may be a huge help to some patients and at worst they will be harmless. “First, I think it would be very useful to people who suffer from things like migraine, asthma, arthritis to have something like this -- a lot of practical value. The other thing is I think it will cause people to think more about the environmental determinants of health generally.”
Wednesday, March 11, 2009
What's in the news: Mar. 11 -- BC hospital fire thwarted
All in a day's work?
An Abbotsford, BC, hospital employee was credited with preventing what could have been a major, fatal explosion at the city's hospital.
When an elderly female patient allegedly ignited her oxygen tank's tubing using a cigarette lighter, the unnamed hospital worker put out the fire with an extinguisher and turned off the woman's oxygen tank, then evacuated 15 patients. He was treated for smoke inhalation, reported the Abbotsford News, but no one else was injured in the incident.
"I think he should be commended for his actions by taking the initiative,” a firefighter said. [Abbotsford News]
Video of the fire:
US stem cell decision may drain our brains
US President Barack Obama's announcement earlier this week that he would overturn the Bush-era ban on federal funding for embryonic stem cell research, sparking fears here in Canada of a brain drain.
Mick Bhatia, the scientific director of McMaster's Stem Cell Biology Research Institute, told the Canadian Press, "The States will be looking to Canada to see if there are people who want to join in their activities now, moving forward with this announcement."
That risk is compounded by what Michael Rudnicki, the scientific director of the Canadian Stem Cell Network, called "very ambiguous and unclear" support for Canadian research scientists under the Conservative government.
"It's like building a hockey team," Rudnicki said. "If suddenly our salary cap is half what it is elsewhere, it can be hard to build that team." [Canadian Press]
An ethos on ethos
An enthusiastic Toronto Star editorial trumpeted the nomination of Dr Jeffrey Turnbull as "a victory for medicare."
"If the debate over health care has sounded off-key in recent years, one reason may be that the leading voice of Canada's doctors has been skewing rightward at the highest levels," began the editorial.
The Star, however, attributed an "ethos" to the entire medical profession that certainly a great many physicians will take issue with. "[Dr Turnbull's] victory is an encouraging sign that, under new leadership, the CMA will change its tune on privatization to become more in harmony with the ethos of Canada's 67,000 doctors, their patients, and most of our politicians."
According to the editorial, "Low turnouts and split votes meant that Ouellet and Day were elected by tiny minorities of the overall membership, resulting in a disconnect with the grassroots." [Toronto Star]
It's one thing to laud Dr Turnbull, but to suggest that Drs Day and Ouellet somehow didn't represent the belief system of all of the country's 67,000 or so doctors... well, that's another thing altogether. Of course, the editorial admitted that the "internal politics of the CMA, like any union or national organization, are complex" but some of that complexity and nuance appears not to have been fully grasped.
Searching for health insurance safety
A new report from the Toronto-based Women and Health Care Reform Group urged provinces to resist lobbying to relax restrictions on private health insurance that duplicates insurance provided by the government. In light of the 2005 Chaoulli v Quebec decision, said the report, there is now "the very real possibility that in Canada, an expanded system of private health insurance will exist in the future."
"Women in particular should be greatly concerned with the movement towards expansion of private health services funded by private health insurance," said the report. "It matters to women if health service costs are covered by public insurance or paid for privately because women, on average, earn less than men and face higher poverty rates." In addition, the majority of workers in the Canadian public healthcare system are women. "Privatized care may contribute to staff shortages and increased workloads, thus undermining working conditions for health care workers."
And, beyond all the health policy talk, the report includes a Women and Private Health Insurance-themed word search (page 2). A rather incongruous but not unwelcome touch. [Women and Private Health Insurance (PDF)]
"A proud but battered bunch"
They tried, but it was tough for the Association of Health Care Journalists to put a positive spin on the results of their new membership survey:
Nevertheless, 88% said if they could go back and do it all over again, they would still choose health journalism. [Association of Health Care Journalists]
Fraudulent pain research
An influential Springfield, Massachusetts, anesthesiology researcher was found to have forged some or all of the data in 21 studies. Dr Scott S Reuben's hospitals notified journals that published his work and they are now retracting it, reported Anesthesiology News.
"This would be the largest research fraud in anesthesia," Dr Steven Shafer, the editor of the journal Anesthesia and Analgesia, told the Boston Globe. "Doctors have been using [his] findings very widely. His findings had a huge impact on the field. The act of fabricating data is so difficult for me to comprehend. It's beyond my ability to imagine."
Dr Reuben had been considered a leader in the study of a field of pain relief called multimodal analgesia. [Boston Globe]
Meanwhile, The Globe and Mail reported that a new software program has been developed to allow medical journal editors to detect plagiarism. Their initial run-through with the software, called eTBLAST, prompted 46 retractions. [Globe and Mail]
At least humour is recession-proof
Canadian Medicine isn't exactly equipped to offer financial advice, but, in the firm belief that crisis calls for catharsis, we can suggest a coping mechanism: Put away your RRSP statements, ditch your copy of the Wall Street Journal, and take a few minutes out of your day to appreciate The New Yorker's online database of medical-themed cartoons.
A few personal favourites: "Either this is the wrong chart or -- let’s just hope this is the wrong chart." And "I'll want to run a few tests on you, just to cover my ass."
Click here to visit their Cartoonbank.com site to view all of the cartoons. Enjoy, and feel free to share some of your favourites with us by leaving a comment.
Sunday, March 8, 2009
When medicine and economics collide: "Awkward"
Here's a great little story from Saskatoon urological surgeon Kishore Visvanathan (right) about an "awkward" exchange he had with an inquisitive med student:
Why, asked the first-year student, did his patient need to come to his office that afternoon just to hear his interpretation of the results of a CT scan? Couldn't he just as easily correspond with the patient, who had difficulty walking and lived an hour away, by mail or by phone and save him the trouble?
Dr V ran through the reasons office visits are necessary and, since none applied to this patient, realized the answer to the "impudent" student's question: "I get paid fee-for-service."
He wrote:
"I don't make patient care decisions based on how much money I'll receive. (Or, I'd like to believe I don't…) But, it's inescapable that incentive drives performance. This is my job - how I support my family. I work in a partnership in which I'm expected to generate my share of revenue. Under the province's medical insurance system, I'm not allowed to bill the government for letters or phone calls to patients. That means any time I spend on those activities is for free. I could send a bill to the patient, but that means some messy bookkeeping for my staff, and might upset my patients. [...]It's worth reading the whole, refreshingly -- even brutally -- honest essay. Click here to check out the rest at Dr Visvanathan's "Adventures in Improving Access" Saskatchewan Health Quality Council blog.
"As long as I'm paid fee-for-service, that's what you're going to get from me: Lots of services that I'm paid for.
"Expect something different? Then I suggest you read On the folly of rewarding A, while hoping for B."
Topics for discussion: Does this incentive conundrum exist for family medicine as well as for specialists? Why doesn't the government health insurance agency simply allow doctors to bill for writing letters and making phone calls? Might Dr Visvanathan's honesty be detrimental to the public image of the medical profession?
Friday, March 6, 2009
What's in the news: Mar. 6 -- NL pathology report is out
Cameron inquiry report released
Justice Margaret Cameron (right) released the final report of her inquiry into Newfoundland and Labrador's breast cancer hormone receptor testing scandal. [Cameron Inquiry final report (PDF)]
The report, as expected, presents a serious condemnation of failures at multiple levels of care, from laboratory testing to government regulatory oversight.
"The whole of the health system, to varying degrees, can be said to have failed the... patients," wrote Justice Cameron, as has been widely reported. [Canadian Press]
Beyond criticizing just the laboratory problems, Justice Cameron also slammed the government for what essentially amounted to a cover-up when health administrators and public officials did not release information about the extent of the problems in a timely manner.
The provincial government has committed to implement around half of the inquiry report's recommendations soon, and will study how to do deal with others that require more time. [Canadian Press]
Meanwhile, Health Minister Ross Wiseman is resisting, with Premier Danny Williams's support, calls for him to resign. Mr Wiseman was taken to task in the inquiry report for his role in the government's failure to initially come clean with the public over the botched hormone receptor tests. [Canadian Press]
Turnbull already making waves
The man nominated to be the next Canadian Medical Association president, Dr Jeffrey Turnbull, admitted to providing his homeless patients with other people's unused prescription drugs. He only distributes unexpired, unopened drugs that are indicated and in the correct dosage for his homeless patients who may not have prescription drug insurance or even a health card, he said.
Technically, he doesn't appear to be breaking any laws though he may be contributing to violations of an aspect of the Drug and Pharmacies Regulation Act, CBC News reported. Dr Turnbull said he realized the practice was controversial, but believed it to be justified.
He and a Nova Scotia oncologist both want provincial governments to develop regulations to encourage drug redistribution. "I think it's a common sense issue where we could come up with common sense guidelines to direct this," he said. [CBC News]
Turnbull's "wet shelter" makes news
The Ottawa Citizen profiled another one of Dr Turnbull's controversial projects, a "wet shelter" that dispenses one drink per hour to homeless alcoholics to help them manage their drinking.
Dr Turnbull is one of the authors of a study in the Canadian Medical Association Journal that demonstrates the health and public safety benefits of the Managed Alcohol Program.
"At the end of the day in this environment," Dr Turnbull told the Citizen, "we're able to minimize the amount of alcohol they use, reduce the harm they experience related to their alcohol, and reduce the harm society experiences because of their alcohol abuse: having these people in the emergency department, involved with police on drunk-and-disorderly charges." [Ottawa Citizen]
HIV/AIDS a "growing epidemic" in Vancouver
There is a "growing epidemic" of HIV/AIDS in Vancouver, where the infection rate is six times higher than the national average, wrote a high-profile team of BC medical researchers in a new study in the Harm Reduction Journal. Over 1% of the city's adults and teenagers now carry the virus. [Harm Reduction Journal]
One in four Vancouver female sex workers have HIV/AIDS, the BC Centre of Excellence in HIV/AIDS researchers Julio Montaner, Evan Wood, and others also reported. Dr Montaner wondered aloud whether it might be advisable for the government to issue a warning to tourists who arrive in the city for the Olympics next year to be aware of the high HIV rate among Vancouver's sex workers. [Vancouver Sun]
HPV vaccination rates vary widely
Canadian provinces have had significantly different levels of success in convincing pre-teen and teenaged girls to get immunized against human papillomavirus in order to prevent cervical cancer later in life.
The Toronto Star reported that Ontario's participation rate is 49%, compared to 84% in Quebec, 83% in Newfoundland and Labrador, and 80% in PEI and Nova Scotia. BC stands at 65.7%, and Alberta and Manitoba have under 55% participation rates. No data were reported by Saskatchewan and New Brunswick. [Toronto Star]
21% of sex assault victims were drugged
More than one in five victims of sexual assault were drugged before the attacks occurred, a new Canadian study reported. [Canadian Medical Association Journal] [Canwest News Service]
Whereas many studies' "limitations" sections explain why the study might not be as persuasive or powerful as it might sound at first glance, this study's limitations are that it may not have captured anywhere near the actual number of cases in which sexual assault victims were drugged.
Other studies from around the world in recent years have implied that druggings for the purposes of committing sexual assault are becoming more common.
In an accompanying commentary, two British physicians provide advice for clinicians on how to deal with patients who may have been drugged and sexually assaulted. [CMAJ]
Cardiologist charged with killing his 2 kids
Dr Guy Turcotte, a young cardiologist in St-Jérôme, Quebec, has been charged with first-degree murder of his two children, ages three and five. Dr Turcotte was hospitalized with what police said was a self-inflicted drug overdose. His wife, also a physician in St-Jérôme, was not in town at the time of the alleged murders. [CBC News]
Health Canada's reticence
Health Canada is asking that a contractor who is to be hired to help clear a backlog of public-information requests will clear all releases by the office of Health Minister Leona Aglukkaq. The Ottawa Citizen called that requirement "a further sign of the politicization of the open-records law." [Ottawa Citizen]
"Hold the community hostage"
Chatham Daily News managing editor Bruce Corcoran complained that Ontario health authorities are the victims of extortion perpetrated by physicians who threaten to quit if their hospitals' emergency services are restructured or closed. [Chatham Daily News]
Healing COPD with helium
A mix of helium and oxygen helps COPD patients and improves the effectiveness of pulmonary rehabilitation, reported Calgary researchers in the journal Chest. [Chest abstract] An accompanying editorial called the research promising. [MedPage Today]
News from our neighbours to the south
Why do doctors come in to work when they're sick and spread diseases? [Slate]
Maine doctors are being trained to perform basic dental procedures as the state experiences a severe shortage of dentists. [New York Times]
Dr Jim Kim, the world-famous Harvard global health and HIV/AIDS expert, has been hired as Dartmouth College's president. "Jim is going to galvanize the movement for health equity," Dr Paul Farmer told the Boston Globe. "To have a physician teacher at the head of a university will seize the imaginations of young Americans and help build this wonderful movement around global poverty issues." Dr Kim said, "The challenge is to not lose our focus in providing a great liberal arts education but also preparing students to make a difference in the world." [Boston Globe]
Tuesday, March 3, 2009
Pro-medicare doc nominated to be CMA president
The candidate for Canadian Medical Association president preferred by the pro-medicare contingent of the medical community has won the Ontario Medical Association's nomination.
Dr Jeffrey Turnbull's election points to what may be a major change to come in the CMA's influential political lobbying, potentially moving away from what has been a voice on behalf of reforming the restrictions on privately funded healthcare delivery embodied by the Canada Health Act. That effort has been particularly strong over the last two years, with outspoken private clinic owners Brian Day and Robert Ouellet holding the CMA's top job.
Dr Turnbull, on the other hand, made it clear in his campaign position statement that his politics differed from those of Day and Ouellet. "Through new partnerships, a clear vision, dedicated advocacy and wisdom we can preserve the rich traditions of medicine within a publicly-funded health care system that serves our patients the way it is supposed to," he wrote.
Dr Turnbull acknowledged the potential policy shift after learning of the election results. "Yes, [my election] would be a movement not in keeping with the direction of leadership we've had," Dr Turnbull told The Globe and Mail. "But I think there are opportunities for that debate to take place."
Barring a last-minute challenge from the floor of the CMA's annual meeting this August in Saskatoon, Dr Turnbull, the chief of staff at the Ottawa Hospital and an internist with extensive experience in treating the homeless, will become the group's president-elect in 2009-2010 and then accede to a one-year term in the presidency in August 2010.
His experience in association politics is somewhat limited. As I wrote in January, Dr Turnbull is "one of the very few candidates for CMA president over the years who has never served on the board of directors of the CMA or a provincial medical association" though he has experience leading the College of Physicians and Surgeons of Ontario and the Medical Council of Canada.
The CMA's news announcement of Dr Turnbull's election notes that his campaign's focus was not only on the public-private balance of the Canadian healthcare system, but also on practical issues affecting physicians across the country. Among the three priorities he laid out on his website, he wrote:
"As CMA president, I will advocate for pensions, changes in tax law, and debt relief. I will also continue the good work CMA has been doing on other aspects of physician wellbeing since financial wellbeing is only one small piece of the puzzle."
He emphasized the need for greater effort on physician wellness in an interview with the Canadian Press yesterday. "If we don't make changes, we're heading into a circumstance where there'll be increasing stress, increasing burnout, increasing difficulties for doctors as they continue to try to do the best for their patients," said Dr Turnbull. "We have to redouble our efforts to supporting them and making meaningful changes. We have to get more physicians, we have to improve their working conditions. And we have to make a healthy health-care system... within which doctors can perform."
