Canadian Medicine

The -- a conference exploring how interactive online tools (web 2.0) can be applied in the medical profession -- takes place in Toronto on September 4 and 5.

I will be taking part in a on medical blogging, alongside Bertalan Mesko, Jennifer Mccabe Gorman, Peter Murray and Keith J Kaplan.

The is packed with lots of interesting-sounding sessions. If you're interested in attending, don't forget to register soon: the deadline is August 31.

A round-up of Canadian health news, from coast to coast to coast, and beyond, for Friday, August 15. Featuring butt-covering hospital gowns, a high school researcher, surgically restoring facial hair, and "duh" science.

Quebec will be the only province not to participate in the revamped Canadian Blood Services national organ-donor registry. A ministry spokesperson told the Montreal Gazette, "Health is a matter of provincial jurisdiction and we want to run our health-care services." The spokesperson also claimed, falsely, that Quebec is "way ahead of other provinces when it comes to organ donation."

The Alberta government has opted not to pay for a provincial syphilis awareness advertising campaign. Health Minister Ron Liepert told the Calgary Herald the ad campaign needn't target the entire population -- only high-risk populations. He also said, "What we need to do is convince Albertans to take some personal responsibility. This is a preventable disease, this is not cancer. This is a preventable disease." The Herald writes, "Liepert's comments came a week after the [Edmonton] Journal reported five babies died of congenital syphilis in Alberta since 2005."

Children born to mothers who underwent stress during the disastrous 1998 Quebec ice storm have lower IQs and poorer language skills than average, according to a new study by two McGill-affiliated researchers published in the Journal of the American Academy of Child and Adolescent Psychiatry. One of the authors told the Canadian Press that this is the first study to examine the effects of stress caused by a natural disaster on mothers. [ abstract]

The British Columbia Court of Appeal has reserved three days next April to hear the federal government's appeal of the BC Superior Court decision that declared Insite, the Vancouver safe-injection site, a health facility and prevented the federal government from shutting it down.

A Cochrane, Alberta, high school student's study demonstrates that the flavour additive MSG slows brain-cell growth.

A Montreal company, with the help of BC Interior Health Authority's laundry manager, has designed a new hospital gown intended to obviate the well-known problem that most hospital gowns have: leaving your butt hanging out in the wind.

Ian Furst discusses Canada Health Infoway's goal of providing every Canadian with an electronic health record by the year 2016.

Today's entry from the annals of "duh" science comes from a Toronto study: teens feel invincible.

Toronto-based blogger Kateland complains of taxpayers' money being frittered away after she receives a safe crack kit in her mailbox, containing crack pipe filters and other materials, as well as condoms. But Kateland's story doesn't hold up under scrutiny: the City of Toronto isn't spending your money on sending out unsolicited crack pipe supplies by mail. Street Health, the distributor of the mailed kits, is a .

The UK will ban size-zero models from fashion shows.

Very few women are entering neurosurgery.

An Australian study shows that consuming Red Bull energy drinks raises stroke risk.

Trouble for the pro-life crowd: Having one abortion isn't associated with more mental health problems, says the American Psychological Association.

The Canadian Society for International Health's conference takes place October 26-29 in Ottawa.

The International Society of Hair Restoration Surgery is holding its 16th annual meeting in Montreal from September 3-7, with over 500 doctors and surgical assistants set to attend. My favourite part of the press release: there will be a session on "Best practices in transplanting facial hair for patients suffering from hair loss as a result of an accident or a serious burn, including cultural considerations for patients who live in areas of the world where a lack of facial hair - such as a moustache - is considered shameful." []

As his one-year term at the helm of the Canadian Medical Association winds down, what are we to make of Dr Brian Day’s presidency?

Dr Day, a Liverpool-born, Vancouver-based orthopedic surgeon and owner of the large downtown Cambie Surgical Centre, was elected to the position in 2006. His election attracted more media attention than that of any other CMA president in recent memory, in part because groups both inside and outside the CMA cast him as the candidate of privatization. In some respects, that is not an unfair characterization -- he does believe that more services could be offered privately -- but on the other hand, Dr Day has repeatedly stressed that he intends to strengthen the public system while expanding private options, an agenda that’s more or less consistent with the CMA’s policy over recent years.

Now, the changing of the guard is just a few days off, at the CMA’s annual meeting beginning on Sunday in Montreal, where Quebec radiologist and businessman Robert Ouellet will assume the presidency. To find out whether Dr Day’s year as president lived up to expectations -- his own, the CMA’s members’, and the public’s -- I spoke to Dr Day recently and also asked several prominent health policy analysts to share their insights about Dr Day’s presidency.

DR BRIAN DAY
Discussing his work over the past year, Dr Day spoke quickly, eager to touch on all his accomplishments. In short, he clearly sees his presidency as a major success. I reminded him of our conversation last year (published as a of the National Review of Medicine last September) when I asked him what he hoped his legacy would be.

SAM SOLOMON: When we spoke last fall, just as your presidency was beginning, you said ‘The number one thing I'd like to see is an acknowledgement that the status quo is not working. Secondly, some definitive action that will achieve a significant reduction — or at least lead to a strategy to make a significant reduction — in all wait lists in Canada. I think it's a realistic goal.” In retrospect, were those goals realistic? Have you accomplished what you set out to accomplish?

BRIAN DAY: Obviously I have never thought I could solve all the problems of the Canadian health system, one person in one year -- never for a moment did I think that -- but there is a strong momentum. The momentum has begun. I think it will carry on.

Throughout our discussion of his work as president, Dr Day exuded confidence. Though he did admit that neither he nor the CMA as a whole can claim full responsibility for the growing awareness among Canadian politicians and the public of the healthcare system’s shortcomings, his pride in his presidency was readily apparent.

Implicit in his response above about accomplishing his goals, however, was his omission of a mention of his second goal: wait times reductions. On that front, progress is less clear than it is on the raising-awareness campaign. One possible explanation for that is contained in Dr Day’s hedging in his answer last year: “achieve a significant reduction — or at least lead to a strategy to make a significant reduction — in all wait lists in Canada.” According to Dr Day’s thinking, the Canadian wait times problem may be intractable until the body politic finally understands what is wrong with the current system.

To that end, the CMA commissioned a (PDF) and Dr Day spent much of the past year spreading the message to just about anyone who would listen.

BRIAN DAY: I did maybe 400 media interviews in past year. I’ve been to 100 meetings, and most of them I have spoken at, not just with doctors but business groups too. I visited many editorial boards across the country, which generated over 40 editorials. Part of what I wanted to impart was to give the public a reality check of where we are at, and the 40 editorials generated mostly agreed that the status quo is not working. A fairly high percentage of the public thinks the system need a reworking. Politicians at the federal and provincial levels understand the status quo is not sustainable... The days where governments just handed over and pumped in more money to the system without requirements for productivity and performance are numbered, and I think rightly so.

According to Dr Day, that means the idea of revising the Canada Health Act is gaining traction. “A minority government is not about to do that,” he admits, “but as it stands [the Canada Health Act] is a hindrance to innovation.”

One group, however, still hasn’t begun to catch on to his lessons, says Dr Day. Labour unions continue to hound him on his support of an expanded role for privatization of both healthcare funding and delivery.

BRIAN DAY: I have never stepped back from my position that the private sector has a significant role to play in healthcare in Canada and the public system needs it. I don’t believe in a monopoly provider of any service. Unfortunately those who have chosen to focus on that debate have been very unhelpful with respect to trying to improve and reform the health system. I think people have to understand in Canada, and certain groups need to understand it better, is that the private sector already plays a large role in the Canadian health system, putting up buildings and MRIs and so on. The concept that successful business is bad for a country is a bizarre notion that some of the public sector unions have tried to propagate. But a successful economy is what provides the revenue and a lot of public unions don’t understand that.

Several of Dr Day’s initiatives have gained significant ground. The doctor shortage is now widely seen as real and growing, thanks in part to the CMA’s 2007-08 advertising campaign in Ottawa and, to a limited extent, nationally. There’s also been progress on convincing provincial governments to move towards service-based funding for hospitals instead of block funding. (For more on hospital funding, read .)

But other major issues remain stuck almost exactly where they were a year ago. Although the CMA has introduced new patient health records software, the rate of adoption of electronic medical records by physicians remains appallingly slow. And despite hints at fundamental reforms in Quebec in the controversial Castonguay report this spring (including talk of allowing physicians to work in the public and private systems at the same time), little substantive change for doctors seems likely to come of the report’s recommendations.

Dr Day’s presidency ends in a matter of days but a final assessment of his work may be premature until we hear the resolutions adopted at the CMA General Council meeting next week. (Keep your eye on Canadian Medicine for daily news reports from the annual meeting next week.) Dr Day gave me a sneak peek at a few of the resolutions that he will be proposing and/or sponsoring:

• The CMA should endorse a pan-Canadian medical licence.
• The CMA should contribute to the creation of a new Canadian Patients Association.
• The CMA should propose “creative solutions” for the expansion of medical schools.
• The CMA should endorse service-based funding for hospitals across Canada.

It remains to be seen, of course, how much of Dr Day’s agenda goes through at General Council next week. But regardless of the results of voting on the individual resolutions, Dr Day’s overall message is that the past year has been a phenomenal success -- a coup, even -- in terms of promoting the CMA’s viewpoints and communicating them to the public and the body politic.

OTHER PERSPECTIVES
Not everybody agrees with Dr Day’s sunny assessment of his own presidency: the critics who opposed him from the get-go have become even more suspicious of him over the course of the last year.

Michael McBane, the national coordinator of the Canadian Health Coalition, a “not-for-profit, non-partisan organization dedicated to protecting and expanding Canada’s public health system,” is perhaps foremost among Dr Day’s critics. The two have clashed throughout the last year; they’ve debated in public and sparred back and forth in the pages of Canadian newspapers. The Canadian Health Coalition has been collecting and publishing articles critical of Dr Day, listed under the heading “Virus Alert: Dr Day’s Doublespeak” on their website, referring to him as “Doctor Profit.”

I asked Mr McBane how he judged Dr Day’s presidency.

MICHAEL MCBANE: Here’s a recent story. I was standing beside Brian Day in the House of Commons at the Health Committee review of the 10-year First Ministers’ Accord on Health Care Renewal. I was struck [by the fact that] the politicians were not interested in controversial, high-risk propositions like changing hospital funding formulas. They are very risky and probably won’t work. Public officials have shown very little interest in his ideas. Even the Tories who are ideologically predisposed to privatization were not going there. There’s just too much risk and no clear, demonstrated benefit for public policy as opposed to the benefits for private investors. If you weigh those as a politician, especially in a minority government, you cant’ go there. In some ways I think he has marginalized the CMA’s influence, to the extent he has pushed those pet projects. They [politicians] are prepared to engage the CMA on health human resources, but not on Brian Day’s hobbyhorses. In some ways I am relieved.

SAM SOLOMON: Is it possible it might be too early to judge whether Dr Day has marginalized the CMA? Government works slowly.

MICHAEL MCBANE: The jury is out, true. But I expected a love-in with the Conservative politicians and Brian Day. The reality is that politicians who are seen as undermining the public health system are risking their lives. That ideological belief is not worth it even for Prime Minister Stephen Harper. He has come to terms with fact that that is necessary if you want to run the country.

SAM SOLOMON: What are your thoughts on the fact that the CMA has chosen Dr Rober Ouellet, who’s espoused many of the same ideas as Dr Day, as their next president?

MICHAEL MCBANE: Again, they risk further marginalization from the mainstream. In a sense I think the CMA has less influence under those kinds of leaders because of the political risk involved, and because a lot of those proposals are not seen as workable or practical or in the interests of the public. The more they pursue wanting to opt out, or work in and out of the public system, they are distancing themselves from the public interest and government. I think they will start to see a more hostile reception, especially at the provincial level where each association has to negotiate with the public health plan. That is where the rubber hits the road. If I was a doctor I would be concerned about that kind of policy marginalization. Doctors are not trained to be entrepreneurs. They are trained to work in the public system and their training is paid by the public. There’s a disconnect between [the CMA’s privatization advocacy] and the responsibilities of physicians.

Dr Gordon Guyatt, a McMaster University professor of clinical epidemiology and biostatistics who’s active in the group Canadian Doctors for Medicare, says Dr Day’s inability to break the deadlock on increased privatization of healthcare shows “the limited effect an individual can have in the course of a year.”

SAM SOLOMON: Has Brian Day had any appreciable effect on furthering healthcare privatization, as people have accused him of attempting to do?

GORDON GUYATT: I think two years ago the right wing was thinking ‘We now have a chance and can make a move,’ and that has only happened to a limited extent in Quebec. Now the whole thing has gone underground. Now they are basically keeping quiet. The political environment has changed. [Dr Day’s] open-challenge strategy has been kind of abandoned by people on his side and that has left him a bit isolated. People like Harper realized they have to be defenders of public healthcare somewhat.

SAM SOLOMON: What about Dr Day’s other goal, to cut or establish a strategy to cut wait times?

GORDON GUYATT: I think he is a bit player as far as wait times are concerned. Governments have made real attempts to address wait times and there have been some positive changes, but those initiatives were begun and extended independent of him. And the sort of thing in terms of wait times that might have been really productive -- which is saying that for various experiments in parts of the country that have been extremely successful, to have made the push to governments across the country to institutionalize these isolated experiments -- somebody needs to do that, and I think if a president of the CMA took that line and was really acting in the public interest, there would be a lot of allies for that. If he were really serious about wait times, it is a missed opportunity.

SAM SOLOMON: What do you think of his successor, Dr Robert Ouellet?

GORDON GUYATT: From what I have heard, he is no better if not worse in terms of representing this branch of the CMA that has no commitment to equity. I have heard, this guy, he places very low value on equity, thus is out of keeping with the Canadian public. In the CMA there are people who rise to the top who represent the right wing, non-publicly spirited, and don’t put high value on equity.

SAM SOLOMON: Dr Day and Dr Ouellet won CMA elections. You don’t think they represent the membership?

GORDON GUYATT: There is a very wide spectrum in the CMA and this is the repeated emergence of one particular faction. I think the people who go to the CMA meeting are not representative of the CMA.

Dr Day’s presidency wasn’t all bad, says Dr Guyatt. He spearheaded several positive initiatives, such as lobbying for more public funding for pharmacare and home care. But those projects didn’t get enough attention, he says. “It would have been nice if he had given that as much play as supporting private healthcare and promoting private care that benefits only the doctors.”

Nadeem Esmail, the director of Health System Performance Studies at the Fraser Institute, a free market Canadian think-tank, has been critical of the Harper government’s handling of the health portfolio, accusing them of failing to enact real reforms -- not unlike Dr Day. He says Dr Day’s focus on raising awareness of the current healthcare system’s flaws has been “very valuable.”

SAM SOLOMON: What’s your assessment of how Brian Day did as CMA president?

NADEEM ESMAIL: The question, then, is not ‘Did Brian Day implement the policies?’ -- the CMA cant do that -- but ‘What did he do to get us down that road?’ In that sense I think his presidency has been very valuable. It has moved us towards a more sensible approach to healthcare. I think his presidency sent a message to governments that the past approach is not acceptable. Canadians are not willing to believe in past rhetoric. They want solutions, not in more spending but in things that have been successful elsewhere in the world at improving universal healthcare.

SAM SOLOMON: Like what?

NADEEM ESMAIL: A lot of what Brian spoke about, and what people were worried about, is that private sector solutions can work in Canada’s healthcare program and will improve the healthcare system based on what we have seen around the developed world. The ideas he brought were not new, but he brought to Canadians the message that a sensible approach to policies, as is used in Europe, in Japan, in Australia, can be very successful in Canada.

SAM SOLOMON: How do you square your approval of Brian Day’s work with the fact that wait times haven’t gone down much in the last year?

NADEEM ESMAIL: Waiting lists are a symptom of a greater problem -- a poorly functioning healthcare system. The solution is going to come from substantial reform of the healthcare policies we employ in Canada. People have to understand the right policy and I think Day did a lot to further that, to help Canadians understand the right policy structure to get shorter waiting lists in Canada.

SAM SOLOMON: Educating the public is all well and good but perhaps the salient question is really whether Dr Day has been able to convince politicians of his ideas.

NADEEM ESMAIL: You have to understand how politicians work. They follow the polls, they want people to reelect them. To affect politicians, you have to get Canadians to understand the realities of sensible approaches to healthcare policy, which makes the old rhetoric of ‘Canada’s great healthcare system’ more and more useless. Now politicians will have to ask how to get shorter wait times to get elected -- that is where educating Canadians is important. […] When Brian Day was nominated and elected to become the president of CMA, all the so-called protectors of medicare came out and said this would be a disaster for Canadians, for universal medicine. But the reality is that Day has pushed Canadians towards a more sensible and ultimately a more successful approach to healthcare policy. Thanks to his presidency we will have a better healthcare system in the future.

Photo: Lyle Stafford

At next week’s annual meeting in Montreal, the Canadian Medical Association will welcome a new president and for the second year in a row he will be a doctor who sees many of his patients outside the public system, leading critics to accuse the organization of pushing for ‘two-tier medicine.’ But the new president, Dr Robert Ouellet, the co-owner of five private radiology clinics in the Montreal area, is undeterred: he says his mandate is nothing less than to come up with a plan by the end of the year to totally remodel the Canadian healthcare system.

In a recent conversation with our reporter Graham Lanktree, Dr Ouellet laid out his agenda for the coming year, explained his comic book allegiances and discussed his need for speed.


You recently wrote in the CMAJ, “I don’t want to change the world, but at least, to have some little influence and to show that there are some solutions that we have, that are working.” What specifically would you like to accomplish with your influence?

Well, we have to look at what’s going on elsewhere because there are experiences in other countries -- I’m talking about the UK -- where they were at the same level as us with wait times five years ago but they’ve succeeded in getting rid of them. We’re a rich country and have wait times of nine months for surgery or more for hip replacement! We cannot accept that. I cannot accept that.

What do you propose?

There have been enough studies, so no more studies. I want to look at what’s been done elsewhere in Scandinavian countries, in Australia, and if we use the same solutions they’ve been using we’ll have the same results. One solution that [outgoing CMA president] Dr Brian Day started talking about this year is patient-focused funding. We have to change the way our hospitals are funded. Not to have global funding, but to have funding focused on the services they give.

So you don’t think a greater role for private clinics is the solution?

No, no. It’s one part of the solution, I’m not putting it aside, but it’s not the solution. We have to look at everything, be open-minded and not just say ‘OK, we have to be only public, public, public or only private.’ This isn’t an issue in other countries, even socialist Scandinavian ones. Sweden has a private system which is small, but it’s there. In Canada people say it’s not possible to have both systems at the same time. I don’t mean to replace the public system with a private one. We still need universal coverage for everyone. We’re just talking about having some complementary services from the private system and to have competition... The CMA has resources, and this year I will try to use those to create a proposal for a new healthcare system. We need action!

Should we be more open to private insurance for care that is publicly insured?

Yes, yes. We have to guarantee to the population that they will have treatment in the proper time. If someone wants to go a little faster, and they want to pay for that, I don’t have a problem with it.

Aren’t you worried about US-style problems creeping into the Canadian system with the emergence of private insurance?

No. One thing we have to do in Canada right now -- and it’s really the time to do it to avoid the problems that they have in other countries like the United States -- is regulate the private sector. Right now all we’re doing is saying ‘Oh, it doesn’t exist. We don’t want to go that way.’ And that stance lets the private sector develop in a wild fashion. Right now Bill 95 introduced in Quebec -- concerning ownership of radiology clinics -- is a good start. It says radiologists must have at least 50% of the ownership of clinics in the province. If we give that to big corporations we will have the same problems as the US. Now is the time to regulate because private care is still not very big, but it will grow.

What’s the biggest concern facing Canada’s physicians today?

They ask for tests for their patients and their patients have to wait. They must see patients again and again because they deteriorate while they’re waiting for surgery. The system isn’t working well, and this is one thing doctors don’t like it at all.

When it comes to licensing foreign-trained doctors in Canada, there’s a perception that the medical profession is acting like a cartel by putting the priority on protecting their own. How can we staunch the doctor shortage and allay concerns about quality of care?

It’s the Colleges [of Physicians and Surgeons] that don’t want to have those doctors, or are putting up so many rules that it takes too much time. That’s too bad, because we need those doctors. At the same time we want doctors that are competent, but I believe we’ve had some Canadians that have done their studies elsewhere, like the US, and when they come back they have to redo their exam and redo everything. That’s not proper.

You’ve talked about your plan to “build bridges between the Franco and Anglo-Canadian medical communities.” Do Quebec’s physicians have a different view of healthcare from the rest of the country?

Well, Quebec is always different. I think that we have good things in Quebec and good things in the rest of Canada, and I will try to bring them together. In Alberta right now they’re doing a great job instituting EMR [electronic medical records], and one of my goals is to tell the rest of Canada about Quebec’s plan for pharma coverage. I want to give the rest of the country a drug plan to cover them, because drugs are part of the treatment.

Why haven’t a majority of Quebec physicians joined the CMA?

There are factors. One, it’s not compulsory, and two you have to pay a fee. Of course you also have the problem in Quebec that some doctors will not like to have a connection with a federal organization because of their political thinking.

A little bit about the American election: whose healthcare platform is better, McCain’s or Obama’s?

Obama is probably more Canadian because he’s open to a universal system. That’s what we have in Canada and that’s what we want to keep.


5 things you didn’t know about… Dr Robert Ouellet

He’s unlikely to gain Spiderman-like superhero abilities because of all the radiation he’s absorbed Well, now we’re doing ultrasounds and CT scans and aren’t in the room with the patient anymore. Of course, 30 years ago we had to be in there with the patient wearing some lead apron. But this is being done less and less and the machines are much better. No, I’m not afraid of glowing in the dark.

His comic book heroes It would be Asterix & Obelix for sure.

Racing runs in his blood One thing I really like, which I don’t think is well known in the rest of Canada, is Formula One racing. I usually try to go when it’s on here in Montreal. My son is an engineer and he worked for three years at the Renault F1 factory in Oxford.

He wishes he could have seen Paul McCartney play on the Plains of Abraham for Quebec City’s 400th anniversary I think I would have liked to be there, but not to wait four or five hours to get in or wait for the restroom. What I’m not really proud of are the comments that come from the MPs who said that McCartney shouldn’t be there because he’s British.

English is not his mother tongue So I have been practicing. But I have to practice a little bit more since I’ll be giving a speech at the CMA meeting here in Montreal. I will have to get used to making speeches in English more this year.

Interview conducted by Graham Lanktree
Photo: Liam Maloney

A new report released today by the Canadian Medical Association says air pollution will cause 21,000 premature deaths across the country this year alone.

The report predicts that by the year 2031, staggering numbers of Canadians will have had their deaths hastened by acute, short-term exposure to smog and other air pollution (nearly 90,000) and by longterm exposure as well (710,000).

To read the 45-page summary of findings (PDF), click on the image below :

In a , CMA President Dr Brian Day commented on the grim statistics:

"With the start of the Olympics in Beijing, much has been made about the poor air quality in China and the effect it is having on our athletes. But we have a serious home-grown pollution problem right here and Canadians, ranging from the very young to the very old, are paying the price."

With air pollution responsible for 11,000 hospital admissions, 92,000 emergency department visits and 620,000 doctor's office visits in 2008 -- and those numbers predicted to rise by over 50% by 2031 -- the economic costs of air pollution's health risks will amount to over $300 billion in total over the next 24 years.

"The data from the [National Illness Cost of Air Pollution] study is clear: we need concrete and real action on air pollution and a national action plan on lung health," said Kenneth Maybee, the Canadian Lung Association's Chair of Environmental Issues, in .

Canadian Health Minister Tony Clement's repudiation last week of harm reduction strategies for treating drug addicts was "pretty embarrassing," as one Ottawa AIDS activist .

Mr Clement (right), repeating one of his favourite talking points, declared:

"Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite... We believe it is a form of harm addition."

Of course, that Mr Clement is opposed to harm reduction is no secret. (He asked Justice Minister Rob Nicholson to appeal a decision by a British Columbia judge that prevents the federal government from shutting down Vancouver's safe-injection site, Insite.)

What was surprising and particularly embarrassing about his announcement last week wasn't really the content of his comments so much as their timing: Mr Clement made his anti-harm reduction claim during an event promoting a World Health Organization guide on fighting HIV and AIDS, at the International AIDS Conference in Mexico City. That guide endorses safe-injection sites as a WHO recommendation.

"It's not my job to kowtow to orthodoxy,” he said, . “I believe I'm on the side of compassion and on the side of the angels."

His comments weren't just embarrassing to Canadian activists , who are familiar with his philosophy, but also to World Health Organization officials, Globe and Mail columnist André Picard. "Clement's Insite attack leaves WHO red-faced," read the headline, which was by the Kaiser Daily HIV/AIDS Report, which provided international news coverage for the conference.

The Globe and Mail also a quote from Insite spokesperson Mark Townsend, who called Mr Clement's comments "depressing silliness." Liberal Member of Parliament and physician Carolyn Bennett said Mr Clement had embarrassed Canada. To get a taste of what Canadians think, just check out the appended to the Globe and Mail's article online.

"What is it about safe injection sites that Clement cannot get his mind around?" the Vancouver Sun's Barbara Yaffe:

"He understands and endorses the need for clean needles. The sites merely add a desk and chair, and health-care oversight to the mix.

"What's more, Clement is proving himself a first-class hypocrite. The health minister doesn't want addicts shooting up; he wants them off drugs. But despite a year of pleas, to date the feds haven't responded to a request for $2 million in capital funding from Vancouver's Central City Foundation. The group is establishing a long-term residential drug treatment centre for young people.

"B.C.'s government has pledged $2.4 million annually for The Crossing at Keremeos, to begin accepting residents in January. So far the feds have contributed zip.

"It's time for Clement to put his money where his mouth is."

In other news from the International AIDS Conference:

On Wednesday, August 6, the Canadian AIDS Society accusing the government of failing to keep its commitment on HIV/AIDS funding and calculating the shortfall in promised money at a whopping $11.8 million.

The next day, the following comment from Mr Clement in the Calgary Sun: Canada is a world leader on AIDS.

In his defence, Canada is indeed the largest contributor in the world to the WHO's AIDS initiatives (though its total commitments to those of the United States), and Mr Clement a further $45 million in southern Africa, primarily Mozambique and South Africa.

But Mr Clement's record is nevertheless tainted by his refusal to accept that harm reduction is a necessary method of protecting drug addicts from contracting diseases like HIV, Canadian AIDS Society executive director Monique Doolittle-Romas said in her August 6 release:

"How can any credibility be given to any funding pledge by the Canadian government when it hasn't even honoured long-standing domestic commitments?"

Photo:

A round-up of Canadian health news, from coast to coast to coast, and beyond, for Wednesday, August 13. Featuring smart pacemakers, clumsy kids, injured cheerleaders and more.

The government of Saskatchewan will reimburse $52,000 in medical bills paid by a woman whose husband travelled to the Mayo Clinic in Minnesota for cancer treatment after being misdiagnosed with Crohn's disease in Canada. The man, Doug Bonderud, died in 2006 despite the treatment. His wife is now suing the Saskatchewan Cancer Agency.

A collection of aboriginal chiefs and environmental leaders are planning a conference on water quality and health problems in Fort Chipewyan this Friday. Three hundred attendees will be arriving in the rural northern Alberta town, including Alberta Liberal environment critic and former public health official Dr David Swann and Dr John O'Connor, the former Fort Chip family physician who was chased out of Alberta by the provincial and federal governments after he publicized what he believes to be elevated levels of unusual cancers that are connected to oil sands water pollution.

Quebec gets its first fully automatic biventricular cardiac resynchronization therapy defibrillator. (Say that ten times fast.) That's a fancy way of saying "intelligent pacemaker." The device, designed by the company Medtronics, adjusts according to changes in the patient's cardiac condition. The procedure was carried out July 17; the patient, a 78-year-old man, was discharged the next day and has more energy now than he did, report physicians. "This is another milestone for us, and a step forward in the treatment of patients with congestive heart failure," says Dr Vidal Essebag. []

Two southwestern Ontario mayors lash out at the province's Ministry of Health after reports that the London Health Sciences Centre (the major hospital facility in the region) is sometimes unable to accept critically ill patients. "It's a pathetic system, it really is," Strathroy-Caradoc Mayor Mel Veale told the London Free Press. "This is playing Russian Roulette with the lives of people," wrote Sarnia mayor Mike Bradley to Health Minister David Caplan.

Dr David Shulman, a chronic pain specialist from Toronto, has arrived in St John's, Newfoundland and Labrador, after biking across the entire country (in two trips over the last two summers) to raise awareness of Complex Regional Pain Syndrome.

As next week's Canadian Medical Association annual meeting in Montreal draws nearer, the list of physician awards is announced, including prizes for young leaders, ethics, political leadership and more. []

Clumsy kids are at risk of obesity as adults, according to a new study. Why? The researchers aren't quite sure.

The most dangerous sport for high school girls: cheerleading. And it's not even close. Two-thirds of all sports injuries in high school girls were cheering related, according to new data. Give me an L! Give me an I! Give me an A! Give me a B! Give me another I! Give me an L!... Alright, you get the idea.

The CBC looks at the impact of Canadian doctor-poaching on South Africa, which has lost many physicians to Canada and other countries. []

Uganda moves ahead with mass circumcision to fight the spread of HIV.

Today's round-up of Canadian health news, from coast to coast to coast -- and beyond.

Canadian physicians, swamped with patients and desperate for relief, are resorting to holding lotteries to determine which patients are to be kicked out of their practices. "It wasn't something that I wanted to do," a regretful Ontario doctor told the National Post. [] []

"The sky is falling! The sky is falling!" Governments are suckers for the Chicken Little fallacy, writes John Lorinc in The Globe and Mail. That is, they're endlessly worried that the aging population will force a massive rise in health expenditures. Not so, says University of British Columbia health economist Robert Evans. [] I wrote an article on the same subject, also with Robert Evans as a key source, a year and a half ago.

An argument rages between the Public Health Agency of Canada and some lyme disease patient advocates over the estimated prevalance of the illness in Canada; the difference between the groups' numbers are immense.

Canadian Blood Services announced today it is merging with the Canadian Council for Donation and Transplantation, and establishing a new national plan to coordinate organ and tissue donations. Three new "priority national registries" will be created. []

An Ontario arthritis lobby "cries foul" on the province's recent decision to invest heavily in diabetes, but not in arthritis. "This is another clear indicator of the Ontario Ministry of Health and Long Term Care's discrimination based on disease-type," announced the group's president. The group is demanding coverage on the provincial drug formulary of five very expensive medications. [Arthritis Consumer Experts press release]

Hospital cleaning staff in Nanaimo, British Columbia, say unsafe cleaning practices have continued despite an ongoing C difficile outbreak that's killed three patients since April.

Colin Campbell, the father of a 15-year-old Coquitlam, BC, boy who died of bacterial meningitis last year, is leading a campaign to warn teens not to share their water bottles in order to prevent the spread of meningitis.

A team of Ontario nurses pile into an RV once a month to go take care of the province's truckers. "It's pretty near impossible to get a doctor's appointment when you're on the road," one trucker told CBC News. "Mostly you sit in the truck, sit in the restaurant, eat greasy food, harden up the arteries a little more."

"Art-gardening" at Bloorview Kids Rehab, in Toronto.

The Boston Globe provides a summary of the best of Massachusetts's doctors' enraged outbursts. A few examples: throwing scissors in the OR, calling a nurse a "lame-brain" and an "idiot," and dropping a 10-pound sandbag on a nurse's foot. []

Over a month after the death of Samuel Golubchuk (left), his family has it has been fighting since Winnipeg critical-care doctors were thwarted in February in their attempt to remove the brain-damaged 84-year-old from a respirator and feeding tube, reports the Winnipeg Sun.

Mr Golubchuk was hospitalized last fall at Winnipeg's Grace Hospital, with pneumonia. His condition deteriorated and physicians told the family further treatment would be futile. The Orthodox Jewish family disagreed on religious grounds and obtained an temporary injunction from a judge in February to prevent the physicians from withdrawing care until a trial could be held. Before that trial ever took place, however, several doctors resigned from providing care for Mr Golubchuk -- and then, after a new doctor was found to attend to him, Mr Golubchuk died on June 24, with the trial still months off. (Read my article .)

For the family, abandoning the legal wrangling must be a welcome respite from the months of conflict since Mr Golubchuk was hospitalized. But for Canadian policymakers, physicians, lawyers and ethicists, the absence of any clarification on this issue -- how conflicts in end-of-life decision-making should be handled -- is a major blow.

"We need resolution on this issue," one of the three doctors who resigned told The Globe and Mail anonymously. "These cases are just occurring over and over again."

Winnipeg bioethicist Arthur Schafer, PhD, told me:

"At the human level I think one has to feel relief for Mr Golubchuk, because he was not in a vegetative state but in a near-vegetative state — he was feeling pain and discomfort. But on the other hand we won't have a court ruling that will clarify the situation."

Heidi Graham, the Winnipeg Regional Health Authority's spokesperson, told the Winnipeg Sun that their physicians are expected to follow the College of Physicians and Surgeons of Manitoba's (PDF). Those guidelines, which essentially declare that the final decision on withdrawing care is to be made by a physician instead of the family, might have been thrown out by the courts if the case had continued; they are "the most insensitive, hypocritical, unfeeling document I have ever read," the Golubchuks' lawyer, Neil Kravetsky, told me.

In the absence of a decision on the Golubchuk case, many questions of national importance remain:

• Was the injunction appropriate?
• Would the family have won the right to demand continued, useless care?
• Were the doctors within their rights to make a withdrawal-0f-care decision unilaterally?
• What are the legal consequences for doctors who resign from caring for a patient because they feel providing futile care would be more harmful to the patient than helpful? Could a court jail a doctor for such a decision?
  
• Why did the Manitoba justice system initially set a trial date nine months in the future when the patient was on death's door, all but guaranteeing the case would not be heard?

Decision or no decision, Mr Kravetsky was claiming victory on all fronts not long after Mr Golubchuk died. "We won the injunction," he told me. "That is a precedent. There are no others in this kind of case. So people who are faced with what Samuel Golubchuk's family was faced with, they know there is something to rely on in the future."

But no one can know at this point what the trial would have decided. If some good could have come from the suffering and strife of Mr Golubchuk's ordeal, then it would have been a clear and purposeful ruling by a judge that would have settled our questions. That will not happen now -- at least not until the next time a dying patient is caught in the crossfire of the ongoing battle over end-of-life decision-making.

A round-up of Canadian health news, from coast to coast to coast (and beyond).

Dr Henry Morgentaler has been granted permission from a judge to proceed with a lawsuit against the government of New Brunswick, to force the government to cover abortions at his private clinic under the provincial medical insurance plan. Many women in New Brunswick use the Morgentaler clinic because the province has the most restrictive laws on access to abortion services in Canada.

BuyDCA.com, the California-based business that sold dichloroacetate online to desperate cancer patients hoping for a miracle treatment until the US Food and Drug Administration shut it down last July, is back up and running. This news won't please University of Alberta cardiology researcher Evangelos Michelakis, who made the discovery that the chemical could shrink rats' tumours. His research was widely circulated and end-stage cancer patients with the (toxic) drug -- in some cases, as I reported last year about a , with doctors' blessings.

Heroic Canadian Olympic rowing coach Bent Jensen is busy working with his team in Beijing while he undergoes chemotherapy for pancreatic cancer, forcing him to use a wheelchair at times during the Olympics. "He's the toughest guy I know," commented a team member.

A Detroit radiologist has begun writing notes explaining why American patients crossing the Canadian border may appear to the Department of Homeland Security's "radiation portal monitors" to be radioactive. Kitty litter and bananas also set off the anti-terrorist alert system. So far, however, no terrorists have been caught using the border scanners. []

Dr Julio Montaner, a UBC professor of medicine and internationally renowned HIV/AIDS researcher, has been named International AIDS Society president. The announcement came during the International AIDS Conference, hosted this year in Mexico City. Dr Montaner recently squared off against the federal government at a House of Commons Health Committee hearing on the merits of harm reduction strategies to combat infection and mortality.

After a meeting with incoming CMA President Robert Ouellet, New Brunswick Health Minister Mike Murphy is ready to sign on to the CMA's patient-based funding idea and is pushing for a federal fund to recruit foreign physicians. "For us it's very refreshing that we see that someone is taking action," Dr Ouellet said.

Lance Armstrong is heading to Montreal next month to cycle and raise money for a McGill University cancer-care initiative. [CMA]

Pharmaceutical companies' press releases are often dishonest, report a team of Toronto researchers.

Saskatoon health board member Eric Braun, who was arrested on drug charges after he was busted for cocaine, magic mushrooms and marijuana , has now also been charged with possession of child pornography.

Breastfeeding mothers held a "nurse-in" at a Vancouver H&M in protest of the store's request to a woman to nurse her child in private. The store has apologized.

In the UK, inclement weather alerts cut hospital admissions for COPD by 20%.

The incidence of polio in Nigeria has risen by 240% since last year.



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