Canadian Medicine

Hamilton police have issued a warning to parents: check your kids' Halloween hauls for Zyban.

That's right -- the smoking cessation medication (which CP describes ) was found in a child's candy bag.

The drug can cause seizures, hallucinations and allergic reactins . But on the bright side, maybe these Halloween meds will prove beneficial for a public health effort: helping kids stay away from cigarettes.

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Jiri Fischer -- the former Detroit Red Wings player who suffered a seizure during a hockey game that caused his heart to stop and was saved by doctors who were quick to use an AED (in the photo, right, his teammates look on during the incident) -- has partnered with the Heart and Stroke Foundation of Canada, the Toronto Maple Leafs and the Calgary Flames to promote CPR education in Canada.

Jiri has not yet been able to resume his NHL playing career - but is happy simply to be alive. He recognizes that he was fortunate that trained staff were on-hand at the Joe Louis Arena to administer life-saving CPR. As a result, Jiri has joined forces with the Heart and Stroke Foundation, and is a tireless proponent of CPR training and the installation of defibrillators in hockey arenas and public buildings across Canada. [...]

Jiri Fischer will be making personal appearances at tonight's Calgary
Flames home game (Calgary vs Detroit) and on Saturday, November 17 when the
Leafs play the Senators.

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First of all, they prefer to call them "rebates."

, responding to the new Competition Bureau report on generic drug prices (see "Generics 'too expensive:' Competition Bureau"), says generic manufacturers' rebates aren't passed on to consumers in the form of savings on the drugs because -- like giving patients advice or helping them sort out their medications, tasks for which the government doesn't remunerate pharmacists sufficiently.

"Without the income generated from the rebates coming from the generic manufacturers, necessary pharmacy services would be going unfunded," Marnie Mitchell, CEO of the British Columbia Pharmacy Association, said in a statement.

"By having regular conversations with patients about their health, and working to optimize drug regimes, pharmacists improve the quality of life and health outcomes for patients, and keep them out of the hospital," Mitchell said.

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The federal Competition Bureau is after commissioner Sheridan Scott gave a speech to the CD Howe Institute yesterday about a new study on generic pharmaceuticals that found, in his words, "Competition stops at the pharmacy level and does not accrue to the end payer."

He said legislation like Ontario's Bill 102, which banned kickbacks to pharmacists for stocking brand-name drugs, was a step in the right direction. However, Bill 102 still allows for a limited version of that same kickback system.

Here's a .

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The Canadian Institutes of Health Research (CIHR), the federal government's main health research funding body, today announced several new research projects it has decided to support. Two among them look particularly interesting -- and timely, considering the ongoing debate in Canada about wait times and healthcare costs.

The most pertinent project is titled "How can we speed-up the process of finding a family doctor?" It's led by Dr Marie-Dominique Beaulieu of the University of Montreal (you can read about her prior publications. She's been awarded $509,405 for 3 years. Here's the CIHR summary of her research.

Health-care systems across the country are investigating the best ways to deliver primary care - is it private practices? Community clinics? Family practice groups? Dr. Marie-Dominique Beaulieu of CHUM at the University of Montreal is comparing these three different models of primary care delivery in 60 centres in three areas of Quebec to find out how they affect quality of care, specifically the management of chronic illnesses. Her goal is to identify structural and organizational factors that support high-quality clinical practices. By linking the different models with measurements of clinical outcomes, Dr. Beaulieu will contribute to the development of a set of tools for measuring primary-care performance taking into account many different dimensions, including clinical outcomes, user satisfaction and the evaluation of care processes.

Intrigued, I emailed Dr Beaulieu for some more details this morning.

Sam Solomon: I was wondering if you could tell me what some of the solutions are that you plan on investigating.

Dr Marie-Dominique Beaulieu: Thanks for your interest in my research. Enclosed are both a brief and long summary of the research project. [The brief one is very similar to the CIHR summary above. Dr Boileau's long summary can be found in the comments to this post.] Our hypothesis is that "organizational" factors may help in increasing the accessibility to a family physicians. Here are examples of factors that we think may make a difference:

• 1. the number of physicians in a given clinic,

• 2. if they work or not in collaboration with other health care professionals,

• 3. the number of allied health professionals they work with (ie do they have only one nurse per 10 MDs or 2 per 5 MDs),

• 4. their appointment booking policies,

• 5. how they network with the rest of the system in their region.

So we will not test interventions in an experimental design but explore from what exists, what appears the most effective way to "free" the time of FPs, so they can offer services to an increased number of patients, and continue to give care of quality. There is also an emphasis on quality of care.

The idea that organizational, administrative variation might account for variability in accessibility is not a revolutionary proposal in and of itself, but Dr Boileau's question about the effect of organizational policy on quality of care is a very important one. As Canada increasingly begins to implement models of integrated healthcare (along the lines of Ontario's Family Health Teams), research on the influence on care of things like clinic size, collaborative care, inter-office networking and scheduling systems is becoming exponentially more valuable.

Another really fascinating looking project is called "Do rising drug costs equal better health and lower expenditures in other areas? The causes and consequences of spending on drugs," by Dr Steve Morgan of the University of British Columbia (you can read his work ). Here's the CIHR description:

Canada will spend roughly $30 billion on pharmaceuticals in 2007, more than half of what we will spend on hospitals and 50% more than we will spend on physicians. It is also more than three times what we spent on drugs just a decade ago, in 1996. If these trends continue, we will spend $85 billion on drugs in 2017, one out of every four dollars spent on health and more than we will spend on hospitals. But there is much we don’t know about drug expenditures: Is spending rising because of an aging population? Is increased use of medicines resulting in improved health? Does spending on drugs generate savings in other components of the health system? Dr. Steven Morgan of the University of British Columbia is finding the evidence to help policy makers better understand the causes and consequences of our spending on drugs. He will examine the use and costs of pharmaceuticals, medical services and hospital care by all British Columbians from 1996 to 2007 to quantify the population-based impacts of prescription drugs on health services utilization and population health.

The other projects for which new CIHR funding has been allocated are: Measuring the health impacts of waiting for a joint replacement (Dr Mark Harrison, Queen’s University); When values conflict in health care - How can we increase work satisfaction and retention of nurses? (Drs Marie Edwards and Susan McClement, University of Manitoba); and Sharing ownership of care - Optimizing home-care resources by involving patients (Dr Carol McWilliam, University of Western Ontario).

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The Toronto Star has been reporting speculation that George Smitherman, the Minister of Health and Long Term Care of Ontario, could be moved to a different portfolio.

On Saturday, columnist Ian Urquhart of possible replacements for Greg Sorbara at the Ministry of Finance. He names energy minister Dwight Duncan the leading candidate. Here's his take on the prospect of Smitherman filling the finance job:

He has won plaudits for his performance as health minister in the Liberal government's first term. And it is noteworthy that McGuinty passed over Duncan to name Smitherman as deputy premier in 2006. Smitherman is a gifted communicator, but he may be too much of a street fighter for the finance portfolio. Also, associates say he wouldn't mind staying on in health for a least a year or two.

In an article , the Star reiterates that moving Smitherman to the Ministry of Finance would likely necessitate a major rethinking of the cabinet and again points to Duncan as the logical choice. A Globe report today .

With collective agreement negotiations looming with doctors, nurses and hospitals (as I write ), it seems to make sense to keep Smitherman in health, at least in the short-term. If not liked, then he is at least respected now among healthcare stakeholders and he's unlikely to repeat the mistakes of 2004. But, with rumours about possible runs for premier of Ontario or mayor of Toronto in a few years, a Smitherman shuffle seems entirely plausible in a year or two.

(Click the photo above to read NRM's Q&A interview with George Smitherman from earlier this year.)

Update, 2:30 pm, Monday -- From the horse's mouth: Smitherman he's happy to stay in the Ministry of Health and hasn't asked to be moved.

Update, 9:20 am, Tuesday -- . Duncan to energy, Smitherman stands pat. One interesting note is the first-ever solo Minister of Aboriginal Affairs. Previously that job had fallen to another cabinet member, alongside their other duties.

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In an excellently reported and photographed piece, The Globe and Mail's Martin Mittelstaedt and Louie Palu examine Canada's "asbestos shame:"

Before asbestos became feared as one of the most powerful cancer-causing agents ever used, it was heralded as the "magic mineral." In an age of impermanence, asbestos offered durability. While it had the texture of wool, it didn't burn and was incredibly resistant to decay. That is why it was once used in thousands of products, everything from car brake pads to insulation on some of the giant steel girders holding up the World Trade Center.

But asbestos has a big problem. When used, it promiscuously sheds tiny dust fibres. Once inhaled, the fibres become tangled in lung tissues, where they wreak havoc — typically lung cancer, asbestosis and mesothelioma, a rare, painful and almost always fatal cancer of the lining of the chest wall. The World Health Organization estimates asbestos kills at least 90,000 people a year — about half of all occupational cancer deaths.

The unfortunate drawback of killing large numbers of people has led more than 40 countries, a who's who of advanced industrialized nations, to outlaw asbestos use. But Canada isn't among them. [...]

Since it's a carcinogen, Canadians don't use much of it any more. Even the asbestos in the Parliament Buildings is being removed. But the country remains one of the world's biggest purveyors of the deadly mineral, selling abroad 95 per cent of the output from the country's two remaining mines, both in Quebec, a business worth about $93-million a year.

The article is worth a read (and the photos are great; click the photo above to see all ten). The article goes on to document the damage that Canadian asbestos exportation (which continues today) has had on India and other developing nations. It also touches on Canada's efforts to block WHO and UN anti-asbestos resolutions, as in , as documented by the Montreal Gazette.

Canadian physicians have for .

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