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Friday, July 23, 2010

Between a rock and a hard place?

Commission a report, then ignore it

With only 94 general practice posts, Prince Edward Island is small, but it's a microcosm of the health budget squeezes being felt around the world. Something needs to be done to arrest the spiralling expenditure ... but what? Time to call in global management consulting firm Hay Group to produce a $200,000 report.

Hay Group, not surprisingly, focussed their attention on one of the province's biggest expenses: doctors. How could the government reduce the amount it spends on doctors? To an accountant, the answer is simple and obvious - have fewer doctors.

That's precisely what the Hay Group is recommending as its report nears completion, and the area in which it finds the most room for cuts is family practice. In fact, Hay suggests cutting the number of GPs on P.E.I. from 94 to as few as 65.

Doing this would naturally require somebody else to shoulder the GPs' burden, and that's what the report recommends, suggesting new roles for nurses, nurse practitioners, and so on.

The province's College of Family Physicians argues it's already adopting these new models. But, says president Dr. Andrew Wohlgemut: "We're not for substituting or getting rid of family physicians and replacing them with other people."

On that issue, it seems, he has friends in high places. On the day the report's recommendations were made public, P.E.I.'s Health Ministry issued a press release trumpeting the hiring of seven new physicians, three of them GPs.

Provincial Health Minister Carolyn Bertram said she won't comment fully on the report until the final draft is submitted to the cabinet in about six weeks, but it seems she's already decided how to address its main recommendation: "We are not cutting doctors' positions," she told the CBC.

Some political realities can still trump even the budget squeeze.

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Future looks bleak for Avandia as safety trial put on hold

Last week saw an FDA panel rule that there is reason to believe the troubled diabetes drug Avandia (rosiglitazone) does indeed increase cardiovascular risks compared to its direct competitor Actos (pioglitazone).

Now, the FDA appears to be moving to shut down the Canadian-led trial that represented the last chance for maker GlaxoSmithKline to prove its drug is safe. The agency put a "partial clinical hold" on new recruitment for the TIDE trial while it updates the lead investigators - Drs Salim Yusef and Hertzel Gerstein of McMaster University - on the results of last week's panel meeting.

While the FDA safety panel stopped short of voting to remove Avandia from the market, the agency can still take action without a vote, and most observers suspect the end is near for Avandia, which has already seen sales collapse in the wake of data suggesting it increases cardiovascular events.

In fact, the same safety concerns were inhibiting recruitment to the TIDE trial. GSK, which agreed in 2007 to fund a head-to-head comparison with pioglitazone, said last week that only 1,100 of an intended 16,000 study participants have volunteered to date.

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Little sympathy for lung cancer patients

A critical perspective

Canadians tend to judge people stricken by lung cancer to a greater extent than do people of many other countries, according to a recent study conducted by Ipsos MORI for the Global Lung Coalition. Although this form of cancer is as painful and frightening as any other, consisting of symptoms that can include coughing (with and without blood), shortness of breath, chest and/or abdominal pain, weight loss, dysphagia, etc., because lung cancer is commonly believed to be brought on by the patients themselves, there tends to be less sympathy towards sufferers.

Survey results found 1 in 5 of us admit to this attitude – generally 22% of our population – with men making up 27% and women 19%. Though the Canadian view has much company among the other 15 countries surveyed, we’re far more critical than those with greater empathy such as Argentina – the most caring country, coming in at only 10%. Countries shown to have the lowest rates of smoking tended to be the least sympathetic to lung cancer patients, despite the fact that 15% of these individuals never smoked and acquired the disease through exposure to radon, asbestos, air pollution or second-hand smoke – often from co-workers or people with whom they live. Regardless of the cause, lung cancer currently kills four times as many people as does breast cancer – roughly 20,000.

Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?

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Monday, July 19, 2010

5 risks to a woman's health

Most physicians believe that too many Canadians eat too much and exercise too little. There are other health risks faced by women in particular. US gynecologist Jennifer Young put together a list of five female risks that can be avoided . It's been one of the most popular items on the Ivanhoe News Wire for the last couple of weeks.

Dr Young's Top Five

1) 50% of women with abnormal pap smears don't follow up.

2) Many avoid birth control pills believing they increase the risk of cancer. Dr Young suggests they actually reduce the risk of ovarian cancer by half. She asserts that studies done in the 1980s that linked breast cancer with the pills turned out to be wrong.

3) Quitting antidepressants cold turkey. Young advises lowering the dosage by ¼ a week for four weeks to mitigate the effects of sudden withdrawal.

4) Drinking too much. Women are smaller, have less body water and lower amounts of an enzyme that breaks down alcohol. She asserts that women who get drunk just once a month increase their risk of heart attack by one third.

5) Not taking folic acid regularly until they become pregnant. She recommends taking the vitamin for six months before pregnancy begins.

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