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What's in the news: Apr. 3 -- Gov't role in pharma study questioned

Feds' role in pharma study raises concerns
Some physicians have expressed concerns about the federal government's role in providing funding for a clinical trial in Quebec offering doctors $100 per patient to enlist new patients to take statins.

The money for the study, called OBSTAT, is being provided by Pfizer and AstraZeneca -- which both produce cholesterol-busting statin drugs -- and the Canadian Institutes of Health Research.

Dr Jim Wright, of the UBC-affiliated Therapeutics Initiative, questioned the government's role in paying for the research. "I'm sure it has some value to the company, but I don't see that it has any value to the public," he told the National Post. "It's a real problem, because it's an incentive for doctors to put people on statins where it may be questionable."

Montreal cardiologist Colin Rose, who received a letter soliciting his help in recruiting new patients to take statins as part of the study, criticized the trial last month on his blog Panaceia or Hygeia. Dr Rose wrote that the physician in charge of the research project has been paid by both pharma companies in the past, and he questioned the scientific value of OBSTAT:

"With 4500 enrolled 'patients' $450,000 will be spent by drug dealers on direct bribes to doctors. If each statin pill conservatively costs $2 per day, in just one year, they will have sold $3.3 million worth of drugs, an almost 400% yearly return on the investment including payments to the doctors. Over three years of the 'study' the drug dealers will have sold about $10 million worth of drugs to people, the vast majority of whom will never have had a heart attack or stroke and in whom, '.' And the cost of this study will likely be classified as 'research' by the drug dealers, not a marketing expense. All perfectly legal. Isn’t the drug business wonderful?"
On his blog Dr Rose also reproduced the letter and background information he was sent on the trial.

The National Post's Tom Blackwell, however, reported that Dr Gordon Guyatt, a senior Canadian epidemiologist credited with coining the term "evidence-based medicine," said that the research has merit.* Mr Blackwell also reported the lead investigator's explanation of the study's scientific value.
[University of Montreal professor] Dr. Jacques LeLorier said the research is driven by the fact that many patients — about 50 per cent in Quebec — stop their statin treatment within a year, though the drugs don't take effect until after about 18 months. That can have "disastrous" implications for the patients' health, and also wastes the money spent by government drug plans, a study summary on the CIHR website says.

As for the payments, they started at $50 per patient, but were doubled because of lack of interest from busy physicians, said LeLorier. The fees are covered by the Pfizer and Astra money, as CIHR will not pay for physician compensation, he said.

Manitoba to cover small fees, relieve doctors of billing
Manitoba doctors will no longer need to collect money from patients for "tray fees" for what had been uninsured services such as suturing supplies, local anesthetics, and other common disposable office items. As of Wednesday, doctors in the province are able to bill the government, instead of their patients, for those items.

"In partnership with the province’s physicians, we are eliminating dozens of tray fees that many Manitobans were routinely required to pay following a procedure at a doctor’s office," said Health Minister Theresa Oswald in a release.

The change is expected to cost the government $1.8 million per year. [Government of Manitoba news release]

Loose nukes
24 moderate- or high-risk radioactive medical devices were either stolen or went missing from 2005 through 2008, the Canadian Nuclear Safety Commission said in a report. All but one were covered, but the CNSC believes the one item "no longer poses a health risk to the public or the environment." No very-high-risk devices were lost. [CNSC report (PDF)]

U of C to look into Nature retraction
Three of the four living South Korean researchers who published an important 2000 research article in Nature -- about using gene therapy to push type 1 diabetes into remission in mice -- issued a retraction this week after failing to replicate their results. One of the researchers refused to sign the retraction and continues to insist that the paper was accurate. Two of the scientists, including Ji-Won Yoon, who died in 2006, were working at the University of Calgary when the research for the 2000 paper was conducted. The university is now investigating the situation.

Allergies in the air
A Regina woman suffered an allergic reaction to a dog that was travelling in the passenger cabin of a WestJet plane. She was disappointed by WestJet officials' response: WestJet said it was the woman's responsibility to warn them of her allergy, whereas she wants WestJet to be take responsibility for warning passengers of the presence of the potential allergen before the flight takes off. "They said they would try and accommodate you as best they could and if they can’t, then they would find another flight for you," said her husband. "Well, we’re paying full fare. I don’t know how much the dog got charged."

This is not the first time passengers and physicians have complained about Canadian airlines' failure to protect allergic travellers.

Parliament is bad for your health
"Dr. Raj Sherman, voted Alberta's sexiest MLA by Journal readers, is regularly hitting the gym to lose the 15 pounds he has put on since he was elected."

MD/MP proposes pot decriminalization
Dr Keith Martin, a Liberal MP from British Columbia, introduced a private member's bill in Parliament on Thursday, proposing to decriminalize marijuana.

The bill would keep marijuana illegal but would change the way the drug is classified such that people caught with 30 grams or less of pot or 1 gram or less of hash, but anyone caught with less than those amounts would still be charged under the Contraventions Act and fined $200 for a first offence. [CTV News] Victoria city councillor Philippe Lucas, the executive director of the medical marijuana organization the Vancouver Island Compassion Society, said he supports the bill but favours full legalization and regulation.

Dr Martin, a former Reform Party MP and physician who currently serves as the Liberal Party's opposition critic for Amateur Sport, Health Promotion and the Olympics, suggested that money raised from the fines could go to fund substance abuse programs. "In the medical profession our mantra is 'do no harm'. We are actually doing terrible harm if we continue to address substance abuse uniquely as a criminal issue from the federal level. The blinders have to come off; we have to take a medical perspective if we are going to reduce harm and drug use in Canada."

Image: Shutterstock

Correction: In the original version of this article, we wrote erroneously that Mr Blackwell had reported Dr Joel Lexchin believed the study had merit.

What's in the news: Apr. 2 -- Quebec and Ontario sign MD-mobility deal

ON, QC give doctors the freedom to move
A new "reciprocal recognition" agreement signed April 2 by the College of Physicians and Surgeons of Ontario and the Collège des médecins du Québec will allow doctors licensed to practise medicine in one province to practise in the other one as well, beginning August 1. [ (PDF)]

"The signature of this agreement constitutes a major first step in the
application of the Agreement on Internal Trade, as the Collège des médecins du
Québec and the College of Physicians and Surgeons of Ontario encompass close
to 80% of all doctors practicing in Canada," said CMQ president Dr Yves Lamontagne, pictured (on the left) shaking hands with CPSO president Dr Rayudu Koka. [CPSO/CMQ joint news release]

One senior Quebec medical specialist's early reaction, published in the Montreal Gazette, was not positive. "The only way doctors will come to work here will be as a humanitarian gesture, like a third-world country," said Quebec Federation of Medical Specialists president Dr Gaétan Barrette, who called the deal a one-way brain drain. Higher pay for doctors in Ontario may lure physicians from Quebec, a CMQ spokesperson admitted in December, when the deal was still being negotiated. "What we fear currently is that there will be more physicians from Quebec who will be interested in working in Ontario," said Dr Yves Robert.

Best health-related April Fools' Day prank?
The funniest/scariest healthcare-related April Fools' Day ruse we saw yesterday was from the South African newspaper The Times, which reported that Dr Manto Tshabalala-Msimang -- the former South African health minister who very publicly opposed the use of antiretroviral drugs to treat HIV/AIDS and whose advocacy instead on behalf of using garlic, lemon and beetroot to treat HIV earned her the nickname Dr Garlic -- would be . The report, written by the fishy-sounding Oliver Sardine, cited "well-placed sources" and its in the paper's April 1 print edition likely caused more than a few South Africans to gasp in horror.

Putting out mattress fires
Health Canada published the country's first-ever safety regulations on the flammability of mattresses in healthcare facilities. "Mattresses that meet the standard will make only a limited contribution to a fire, especially in the early stages of the fire," the announcement said. "This will allow occupants more time to discover the fire and escape." Until this month, no such regulations existed. [Health Canada]

All her world's a stage now
Ontario GP-cum-playwright Florence Gibson's latest play, Missing, is playing at Toronto's Factory Theatre. [Factory Theatre] The play has received more attention than her previous plays have, including press from the Toronto Star and CBC.

HIV crime lecture coming up
Next Wednesday, University of Toronto bioethicist Thomas Foreman will give a lecture on "The Aziga Case and the Criminalisation of HIV Transmission in Canada" as part of the Joint Centre for Bioethics's lecture series. The lecture will be simultaneously broadcast online .

Technophilia and technophobia
An Atlanta hospital's emergency department has begun using radio-frequency identification software to track the movement of all its doctors and patients in real time. Emory Hospital's goal is to discover how nosocomial infectious diseases are spread, according to hospital VP Dr Douglas Lowery-North. "We use the data in a number of ways, notably to quickly and accurately identify and contain infectious disease." This is an undeniably cool and clever use of technology in healthcare, but isn't it just as undeniably creepy? How'd you like your boss tracking exactly where you are at any given moment, or how much time you spend in the john, or which colleague you're surreptitiously sneaking off to the broom closet with during your lunch break? Not that any medical professional would ever...

What's in the news: Apr. 1 -- Journal stirs up Gaza-Israel trouble

BREAKING NEWS: All 10 provincial and three territorial governments announced that, in light of a comprehensive "common sense" review, they will enact the following reforms immediately:

  • jointly funded pensions will be made available for private-practice physicians;
  • billing codes will be created to pay doctors fairly for remote consultations by telephone, email or video uplink;
  • reasonably significant portions of health budgets will be dedicated to disease prevention, health promotion, and chronic disease management;
  • efficient methods of evaluating foreign-trained doctors will be put in place;
  • and compensation will be provided to developing countries whose doctors they recruit to come to Canada.
In other news, federal aviation regulators said pigs will be granted commercial airline pilot licences. Happy April Fools' Day. (And sorry for getting your hopes up.)

And now for the real news...

CMAJ under fire for Gaza articles
Canadian Medical Association Journal editor Dr Paul Hébert implicitly admitted that his journal may not have covered both sides of the story in its two-article coverage last month of the health impact on Palestinians of the recent war in Gaza. [CMAJ editor's note]

After the two articles -- Christopher Mason's "Gaza's health care system crippled before — and after," which described the devastation wrought by Israel's 18-month-long blockade; and "On the ground in the Gaza strip," by Francois Dumont, about a Palestinian doctor and a Palestininan nurse (pictured right) who treated patients in Gaza City throughout the war -- were published in the March 17 issue, 240 letters poured in over just a few days, many expressing outrage that the journal had seemed to focus on the deaths and injuries to Palestinians in Gaza without contextualizing the matter by also describing the deaths and injuries to southern Israelis caused by rockets fired from Gaza.

The balance of the letters, many of which were written by physicians, scolded the journal for publishing what one person called "Palestinian propaganda" and what others saw as a willful ignorance of Hamas's role in creating the dangerous medical conditions in Gaza. Some letter writers, albeit fewer in number, commended the CMAJ editors for publishing the "ghastly truth." (You can read all the letters here and here.)

Alberta health reforms struggling
New data showed that wait times have lengthened over the past year in Calgary for emergency care, surgeries and longterm care placements.

"Things have deteriorated substantially in recent months," said Dr Tom Noseworthy, a wait times expert from the University of Calgary. "It's at an all-time low for me. I've never seen it like this."

The problems' growth complicates claims the provincial government made last year when it unveiled sweeping reforms to the province's health governance structures, particularly its decision to abandon regionalized administration in favour of a single centralized decision-making body based in Edmonton. "There needs to be a massive and quick infusion of new people into the healthcare workforce in the province of Alberta," then Alberta Liberal health critic Dave Taylor told me at the time. "Just rearranging the board governance system doesn't address that — it's like rearranging the deck chairs on the Titanic, when in fact somebody should be grabbing the wheel and changing course."

Ken Hughes, the chair of the new "superboard," said to the Calgary Herald of the new statistics, "Some measures... in health care were at least as good as they were a year ago... There are some that are not as good. We're not happy about that."

The Calgary Herald's editorial board rebuked Mr Hughes's optimism that things would soon improve in Calgary. "A risky operation gone wrong" was the description the editorial board applied to the "deregionalization" plan. "Why has the province gone down this road, reversing a system that was working? The Alberta model was a success, it's been copied by other provinces and has received international recognition. [...]

"Health Minister Ron Liepert said: 'I never anticipated in the first year or even the first couple of years that we would actually see improvements on the front line.'

"There is a vast difference between seeing no improvements and having health-care outcomes plummet. For those Albertans unlucky enough to need a system they have paid into their whole lives at this time of transition, Liepert's comments must be sickening."

Kelowna cancer test controversy
A controversy has exploded in BC about what some claim are over one year's worth of potentially botched breast cancer pathology tests in Kelowna. Dr Kirk Ready, who was lab chief at the Interior Health Authority until he resigned last year, wrote a letter last month in which he described conditions at the lab as "filthy" and some of the practices employed by the lab as "jaw-dropping."

"In the worst episode that I became aware of, 19 bodies were being stored in the [Kelowna General Hospital] morgue," he wrote in his letter. "The cooler only held 12 bodies, required that staff rotate the bodies in and out of the cooler to slow decomposition."

Interior Health officials are now reviewing cases from that time period and will issue a full report soon. Pressed for a full investigation, Health Minister George Abbott demurred, maintaining that "No inaccuracies have been found." Dr Ready has refused to back down from his claims despite Mr Abbott's comments.

Dr Ready guessed that there could be as many as 109 patients affected by problems at the Kelowna laboratory, and also claimed he had been told to keep quiet about problems there during the current election campaign. Daily Courier


If there are indeed systemic problems in Kelowna, this would become the fifth major incident over the last several years in which Canadian pathologists or laboratories have been faulted for committing multiple errors. Recent incidents have arisen in Newfoundland and Labrador, New Brunswick, Ontario and Manitoba.

BC docs reach accord with government
92% of BC physicians who voted approved the new two-year agreement with the provincial government. "I thank the BC Medical Association for focusing their efforts on targeted health system improvements that will continue to make British Columbia’s world-class health system even better," said Health Minister George Abbott.

The agreement will add $180 million in new funding for physicians over the next two years, though only a small portion will go towards doctors' fee increases. In each of the next two years the agreement will give BC physicians just 0.5% fee increases, intended to offset rising overhead costs. (As a point of comparison, consider that the Canadian dollar's inflation rate is currently 1.4%.) The remainder of the money will be distributed to doctors depending on their age, their practice's location (rural or not), and their specialty, in an effort to increase recruitment and improve retention.

"In these tough economic times, we’re pleased that the emphasis on physician recruitment and retention in B.C. remains a high priority for government," Dr. Bill Mackie, the president of the BC Medical Association, said in the government's press release. "This is a good agreement that will help fill the void in many areas of the province that lack GPs and specialists."

Green and unclean
Quebec Ministry of Health officials warned that some of the environmentally safe disinfectant products used by 70% of Quebec healthcare facilities are not sufficiently powerful to protect patients and practitioners. Some experts have blamed the problem on a lack of regulation of manufacturers of disinfectants.

Is Chaoulli a straw man?
The Supreme Court of Canada's 2005 Chaoulli decision, which overturned Quebec's ban on private insurance for certain surgeries when long wait times exist, was described across the country as a major blow to restrictions on private health insurance. But in the intervening years, no insurance companies have sold any such surgical policies in Quebec. Health Minister Dr Yves Bolduc attributed that to the government's success at reducing wait times. "We have such a good access to the surgeries in Quebec, that the industry knows they won't be able to sell any insurance to anybody," he told CBC News.

Teen psych care at issue in NS
Nova Scotia's Progressive Conservative Health Minister Karen Casey sparred with NDP health critic Dave Wilson last week over Mr Wilson's accusation that excessively long wait times for adolescent mental health services are the fault of the government's poor planning.

Agent Orange pay protest
Widows of military veterans from CFB Gagetown, in New Brunswick, protested the federal government's compensation package for victims of Agent Orange exposure. The widows cannot receive compensation for their husbands' exposure because their husbands died before the date established by the government as an eligibility cutoff.

College was right in cosmetic surgeon case, review finds
Ontario's Health Professions Appeal and Review Board declined to find fault with the decision by the College of Physicians and Surgeons of Ontario's complaints committee last year that the general practitioner Behnaz Yazdanfar had not violated any of the college's policies by performing cosmetic surgeries. The review was requested by Dr Terry Polevoy, of Waterloo, who initially complained to the CPSO about Dr Yazdanfar marketing herself as a cosmetic surgeon in 2006. "I am deeply disturbed by their ruling," said Dr Polevoy in an email to reporters. "Is their [sic] nobody at any level who will take responsibility for what happened. There are no appeals to be made above HPARB. This is unforgivable."

In 2007, one of Dr Yazdanfar's patients died after a liposuction procedure , which provided the impetus for changes in the way the CPSO regulates GPs who perform cosmetic surgeries. [Canadian Medicine]

Miracle drug or mediocre shrug?
A five-in-one cardiovascular drug made in India called Polycap, about which a study led by McMaster University researchers was published in The Lancet on Monday, has got reporters around the world worked up into a tizzy of excitement.

The 12-week study, conducted on 2,053 people in India, showed that low-dose Polycap -- a once-daily pill containing 12.5mg thiazide, 50mg atenolol, 5mg ramipril, 20mg simvastatin and 100mg aspirin -- reduced blood pressure, LDL cholesterol levels and heart rate, and the researchers theorized that the drug could be used to prevent cardiovascular problems.

Among the researchers' claims was that the polypill could potentially decreased the risk of suffering heart disease by 62% and of having a stroke by 48. [McMaster Daily News] Because the trial was just 12 weeks long, however, those numbers are extrapolations based on the short-term findings.

McMaster's Dr Salim Yusuf, the principal investigator of the study, presented the results at the American College of Cardiology's annual meeting in Orlando on Monday. The drug, he said, would "certainly revolutionize heart disease prevention as we know it."

University of Minnesota health journalism professor Gary Schwitzer, though, called much of the lay media's enthusiasm "hyperbole" and "very premature." He pointed to the Associated Press's more balanced coverage, which warned of dosing problems, as well as the notion that we should treat people for heart disease before they show any signs of needing treatment for it.

Evidence-based researcher wins award
Receiving a Gairdner Wightman award on Tuesday for his leadership in Canadian medicine, McMaster epidemiology professor Dr David Sackett dedicated the award to "to every patient who has ever been put at a disadvantage because of medical ignorance and arrogance."

Charity appeal from Canadian medical aid group
The "Donate a Day for Africa" campaign asks physicians to donate their income for April 7 to support Canadian Physicians for Aid & Relief's work in rural Africa. Last year 110 health professionals donated more than $70,000. This year CPAR's goal is to get more than 200 health professionals to contribute $140,00. Early donations have already come in from 118 people, for a total of $52,572. [Donate A Day For Africa]

"In these challenging times..."
The recession has presented a tough advertising challenge for Montreal plastic surgeon Arie Benchetrit. On April 7, he'll be discussing "how to maintain a youthful appearance at a relatively low cost in these challenging times." (Relatively being the operative word, of course.) There's no need to worry about the "imagined" cost, he suggests: Botox goes for under $400 and microdermabrasion for the low, low price of $150! "Looking good," crowed his Cosmedica clinic's press release, "doesn't have to be expensive!" [Cosmedica news release]

Every last one?
The US Preventive Services Task Force recommended screening all teenagers -- with or without symptoms -- for depression. [Associated Press]

Pharmaceutical firepower
Merck allegedly sought to discredit physicians who questioned the safety of its since-withdrawn painkiller Vioxx. "We may need to seek them out and destroy them where they live," wrote one Merck employee in an email exposed in an Australian court.

Medical mistakes in Boston
A special issue of Grand Rounds all about medical errors is online at Running a Hospital, the blog of Paul Levy, the president/CEO of the giant Beth Israel Deaconess hospital in Boston.

Coincidentally (I think), Boston surgeon Loren J Borud received the dishonour of being named the Poster Child of Medical Malpractice 2009 by the Thai website YOxyz, to commemorate his achievement of falling asleep while performing surgery at Beth Israel Deaconess Medical Center, leaving his patient with a number of complications.

Constant aaaarghs
The formula for calculating a general practitioner's anguish:
"A=P(LxVx1,000/T)+F+M+H, where A is anguish in Aaaarghs!, P is the number of annoying things the patient says (while I’m here, I don’t know where to start, there’s just one more thing, and so on), L is how late you’re running, V is the number of visits allocated to you that day, T is the previously calculated time available per item, F and M are constants of 100 Aaaarghs! each, added if it’s Monday morning or Friday evening, and H is the number of days since your last holiday."
That's from the hilarious and uproarious British doctor-blogger who goes by the pseudonym Copperfield.