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IN THE NEWS: Newfoundland premier in US for surgery

Danny Williams in US for heart surgery
Danny Williams, the multimillionaire Newfoundland and Labrador premier, has gone to the United States to have heart surgery. According to his staff, the operation he needs is not available in Newfoundland. What is that operation, however, and is it available elsewhere in Canada? Those are questions the premier's office has yet to answer.

Mr Williams's decision to head south for healthcare, like former MP Belinda Stronach's before him, has ignited controversy on both sides of the border about the pros and cons of the Canadian and American health systems.

In an editorial, the Montreal Gazette complained that private care should not only be available to the wealthy and lamented the fact that the Supreme Court of Canada's 2005 Chaoulli decision, which overturned elements of Quebec's ban on private health insurance, has not opened up a private-care market in the province. "Two tiers are acceptable to our elites, apparently, provided there's no third-tier option in between, for ordinary people."

The Globe and Mail, meanwhile, dug up a few surgeons -- including Conservative Senator Wilbert Keon, a famous heart surgeon -- to testify that it's unlikely Mr Williams (pictured above, with his pal Arnold Schwarzenegger) really couldn't have had some operation performed in Canada. Dr Keon said there was "no question" Mr Williams could have received treatment in Canada. "He's going to have to admit that when he recovers and has to face you guys [journalists]." Dr Keon also speculated that Mr Williams simply wanted the luxurious rooms and amenities offered at private American clinics. [Globe and Mail]

On the other hand, nobody knows what the operation is still.

That hasn't stopped people like Dr Keon and throngs of free-market political activists in the United States from jumping to conclusions. "[W]ith his own health on the line, he prefers to put his trust in the "second-rate, profit-driven health-care behemoth" south of the St. Lawrence, rather than try a hospital in Canada," crowed one editorial entitled "Oh (no) Canada."

QC docs denied pay for volunteer work
A group of Quebec orthopedic surgeons volunteering in Haiti learned that their request to be paid government salaries while they're working overseas has been turned down. Health Minister Dr Yves Bolduc said he was worried that paying them would set a precedent that the government was not prepared to commit to.

New U of T med school campus to open
A new campus of the University of Toronto's medical faculty, called the Mississauga Academy of Medicine, is set to open next year. The first class will include 54 students. [Government of Ontario news release]

Autism/vaccine doctor labeled "unethical"
Dr Andrew Wakefield, the British researcher who conceived of the theory linking the measles-mumps-rubella (MMR) vaccine to autism, was censured for unethical and unprofessional research practices by the UK's General Medical Council. [ (PDF)]

Shortly after, The Lancet issued a full retraction of the paper Dr Wakefield published in 1998, "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children," which set off the anti-vaccine movement that still persists the autism community and beyond. [ (subscription required)]

Chronic diseases on the rise
In a new report, the Ontario Medical Association said that the number of patients with diabetes in the province increased by more than 50% between 1995 and 2005, and the prevalence of hypertension rose by nearly 100%. The numbers prompted OMA President Dr Suzanne Strasberg to scold Ontarians: "Ontario's doctors will continue to diagnose, treat and manage chronic disease however; patients also have a responsibility to help themselves by making small and simple choices that can have a significant impact on their health." [OMA news release]

Shingles vaccine recommended for Canadians older than 60
Canadians 60 or older should be given Zostavax, a recently approved shingles vaccine, recommended the Public Health Agency of Canada's National Advisory Committee on Immunization. The committee noted that it's unclear whether patients who have already had shingles can benefit from the vaccine. Also unclear is whether the vaccine will confer protection for more than just a few years. "The efficacy of protection has not been assessed beyond 4 years and it is not known whether booster doses of vaccine are beneficial." [NACI statement]

The Canadian Pain Society urged federal and provincial governments to cover the costs of vaccination for all Canadians over 60. [CPS news release]

Bar codes could help reduce drug dispensing errors, patient safety advocates insisted. [Canadian Patient Safety Institute news release]

The Canadian Association of Physicians for the Environment and the Suzuki Foundation joined forces to launch a new blog called Docs Talk. The blog will feature articles written by Canadian doctors about the connections between the environment and human health. The first entry was written by Dr Warren Bell. "It has long been a cherished belief of the doctor that administering medicine to his or her patient is an unmitigated good. We now know that this is a simplistic point of view. Many pharmaceuticals — especially newly synthesized ones — wreak havoc on animals and plants exposed to them after they leave the human body. It is painful for me and my colleagues to learn that our efforts to do good can sometimes do very bad things."

In many hospitals, women in labour are given only water to drink and ice chips to eat -- no matter how long the labour lasts. A new study published by an international team of researchers, including one Canadian, in the Cochrane Library has determined that the evidence doesn't show any benefit from withholding food and drinks like juice.

Serotonin deficiency may be behind sudden infant death syndrome (SIDS), new research found. [Toronto Star]

It appears to be more effective to use nicotine patches longer than they're usually indicated for, according to a new study. Six months of use improved the quit rate compared to the standard two months of therapy by a whopping 64%.


IN THE NEWS: Radioisotope-producing plant shutdown drags on

Chalk River nuclear plant to stay closed even longer
Is there anyone who is genuinely surprised to learn of further delays in reopening Atomic Energy of Canada Limited's Ottawa-area Chalk River nuclear facility?

Chalk River, which accounts for half the world's production of technetium-99 (an important radioisotope used in medical imaging exams), has been shut for repairs since leaks were discovered last summer. The temporary closing is only the latest of several in the past two years, and the series of shutdowns have thrown the nuclear medicine community into panic.

The nuclear plant's operator, AECL, announced last week that it wouldn't meet the March deadline it had proposed in late 2009. The new goal is to have everything up and running in April. [AECL news release]

The announcement should come as no surprise to readers of Canadian Medicine. No one likes a braggart, of course, but I can't help pointing out that, over a month ago, I predicted the March deadline wouldn't be met. [Canadian Medicine] The only surprise is that vindication came so far in advance of the actual deadline.

Surreptitious, unconscious pelvic exams exposed
Seventy-two percent of patients expressed disapproval of allowing medical students to practice doing gynecological exams on patients who have been anesthetized for a surgical procedure without obtaining consent, which is commonplace in teaching hospitals. The survey, which brings to light a practice that doctors and students have not spoken about widely in public, was conducted by a team of doctors and researchers from the University of Calgary and published in the January issue of the Journal of Obstetrics and Gynecology of Canada. [JOGC abstract (PDF)]

The Globe and Mail's medical columnist André Picard called for an end to the exams being done without consent, calling them unethical. "Patients have a right to say 'No.' They are not merely a collection of body parts to be practised on." wrote Mr Picard. "Patients are due respect and ethical treatment, whether they are awake or anesthetized, and no matter how potentially embarrassing the procedure may be." [Globe and Mail]

Quebec MDs request regular pay for Haiti volunteer work
Quebec orthopedic surgeons who volunteered to go to Haiti are now formally requesting that the provincial government pay them $704 per day while they're away. "A spokesperson for the Quebec's association of orthopedists said that while doctors are volunteering in Haiti, they still have bills to pay in Quebec," reported CBC News. The Quebec Ministry of Health has not responded to the request yet.

Alberta cuts prices of generic drugs
The Alberta government has negotiated a reduction of around 25% in the prices of generic drugs. [CTV News]

Ostracizing smokers poses health threats: MD
In his new book "Écrasons la cigarette pas les fumeurs," published last month by Québec Amérique, Quebec psychiatrist Jean-Jacques Bourque says some smokers are harmed by overzealous doctors' urgings to kick cigarettes. Dr Bourque "démontre comment Santé Canada se prête à une propagande de peur en occultant les risques qu'affronte une certaine partie de la population en cessant de fumer." (He shows how Health Canada has undertaken a propaganda campaign of fear without recognizing the risks that a certain portion of the population faces by quitting smoking.)

Dr Bourque says he thinks many psychiatrists agree with his views but are contradicted by other specialists. [Le Soleil]

"I think we need to show compassion, empathy and understanding towards those who are dealing with such difficulties instead of setting them aside," Dr Yves Lamontagne, the president of the Quebec College of Physicians, told the Montreal Gazette. Dr Lamontagne, who quit smoking two years ago, wrote an introduction to Dr Bourque's book.

Dosage may need adjusting by patient weight
A new paper in The Lancet says drug dosages should be tailored to patients' weights. [ (subscription required)]

Dr Matthew Falagas, one of the report authors, said of himself (198 pounds) and a female student of his (120 pounds), “If we go with the same diagnosis of pneumonia or bronchitis to a New York hospital today... we will be given the same dose of antibiotics," he told The New York Times. "I should receive almost twice the dose compared with her.”

Orbinski gets Order of Canada
Dr James Orbinski, a University of Toronto professor of global health and the former Médecins sans frontières international president, was awarded membership in the Order of Canada "for his contributions as a physician who has worked to improve health care access and delivery in developing countries, and as an advocate for those who have been silenced by war, genocide and mass starvation." [Governor General of Canada news release] Also awarded on the same day were film director and producer Ivan Reitman (whose oeuvre includes"Ghostbusters" and "Stripes" as well as "Kindergarten Cop," "Trailer Park Boys: Countdown to Liquor Day" and many others) and hockey star Mario Lemieux.