Canadian Medicine

The federal government's promised inquiry into last year's deadly outbreak of listeriosis, which had been stalled because no one was appointed to lead it for months after it was announced, is finally getting underway. Former Edmonton health authority president Sheila Weatherill (right) has been selected to take charge of the inquiry. Her report is due July 20. Concerns, however, have been raised about a potential conflict of interest for Ms Weatherill, who also serves as an adviser to the Prime Minister on how to improve the nation's public service. "I think it's pretty clear: Ms. Weatherill can be a cheerleader for the public service, or she can be an independent investigator of the public service,” the University of Ottawa's Amir Attaran told the Canadian Press. “But she can't be both at the same time." Liberal Party Health Critic Dr Carolyn Bennett also criticized the inquiry, saying the mandate is not broad enough. "It is only through a full judicial inquiry that all of the facts will be known - and only then can the families of the victims move forward and Canadians can be assured it won’t happen again."

HRT fears hurt women, says review
Hormone replacement therapy is safe for short-term use by younger menopausal women, a new Society of Obstetricians and Gynecologists of Canada review concluded. The SOGC review contradicts several major findings of the seminal 2002 Women's Health Initiative study that first raised alarms about the widespread use of HRT, including the purported links between HRT and breast cancer, and HRT and heart attacks. [ (PDF)] "Not all women need HT, but many with troublesome symptoms were needlessly scared away from that option due to misunderstandings about the actual risks associated with it,” Queen's University reproductive endocrinology professor Dr Robert Reid, who led the review, said in a release. Of concern to the SOGC was the prospect that many postmenopausal women weren't receiving HRT for the prevention of osteoporosis-related bone loss and fracture. []

Grit shuffle leaves health be
Liberal Party leader Michael Ignatieff revised the party's shadow cabinet positions today. Dr Bennett remained health critic.

'What nursing shortage?' Quebec study asks
Montreal researchers said that Quebec's frequently cited nursing shortage has been vastly overstated. Adding 1,807 nurses, as has been suggested, wouldn't reduce wait times or improve patient care, the Center for Interuniversity Research and Analysis on Organizations report said. One of the reasons for the incorrect estimates in the past is the "lower work intensity" of Quebec nurses, who work an average of 10% less per week than do nurses in the rest of Canada and are more likely to be part-time employees. [] [ (PDF, French only)] The president of the provincial nurses' union said the report was just a guise to promote more private-sector involvement in the healthcare system. "Quebec nurses work just as hard as their colleagues in the rest of Canada and we want to continue working in a public milieu," said Line Bonamie.

In the literature...
Four Canadian researchers, including BC provincial health officer Dr Perry Kendall, have been "thinking the unthinkable." In an essay published in the journal Public Health they suggested that the rising popularity of prescription opioid abuse might actually be a good thing because the prescription drugs aren't injected, are of high-grade medical quality, and because prescription drug abusers are less likely to commit dangerous crimes than heroin users. Admitting their idea is "speculative" and has no data to back it up, they make the phenomenally controversial statement that "An unorthodox way of thinking about the increasing prevalence of PO use among street drug users might be as an unsanctioned or indirect form of 'medical opioid substitution.'" [ (no abstract available)]

A British Columbia experiment in which the government pushed patients to use a cheaper proton pump inhibitor ended up costing the province more money and was, on the whole, detrimental to patients' health, a study published online last week in the journal Alimentary Pharmacology & Therapeutics said. The plan was intended to save the healthcare system $42 million. It ended it costing over $43 million more than would have been spent if the drug change hadn't taken place.

Cocaine users who develop agranulocytosis might have snorted a line from a batch spiked with the veterinary antiparisitic drug levamisole, suggested three researchers from the University of Alberta.

A big, preemptive dose of fluticasone at the beginning of a child's respiratory infection cuts in half the likelihood that the infection will progress to the point that it needs to be treated with steroids, reported physicians from Quebec and UBC in a new article in the New England Journal of Medicine. However, they wrote, "Given the potential for overuse, this preventive approach should not be adopted in clinical practice until long-term adverse effects are clarified."

Fear of experiencing anxiety makes patients with generalized anxiety disorder worry more, which in turn contributes to their anxiety, reported a pair of Concordia University psychology researchers in an article published online ahead of print last month in Behaviour Research and Therapy. In other words: anxiety breeds anxiety. If that isn't enough to make you worry, I don't know what is.

72% of patients admitted to the emergency department with minor head injuries have full-blown concussions, and almost 90% of them still suffer from post-concussion sympotoms one month later, said Queen's University researchers in a study in the Journal of Emergency Medicine.

A protein called FimH might improve people's immune reactions and "can potentially be used as an innate microbicide against mucosal pathogens" or even cancer, wrote a team of researchers from McMaster and Guelph in PLoS Pathogens. "Another way to fight these diseases is to empower our own defense system to deal with the infections, or cancer," said McMaster pathology and molecular medicine professor Ali Ashkar. "This is the basis for emerging interest in factors/molecules which can boost our very own innate defense system." []

Here's some disturbing news about the Canadian donated blood supply. Until guidelines were introduced last year, there was a great deal of mostly incoherent variation from hospital to hospital on the question of what would trigger an investigation into the cause of an infection after a blood transfusion. (This can be of immense importance because if one bag of blood has been contaminated with harmful bacteria, other bags may need to be tested.) [ (PDF)]

The publishers of Doctor's Review, Parkhurst Exchange and Canadian Medicine are pleased to introduce , a peer-to-peer video sharing site exclusively for health professionals.

features streaming videos about clinical treatments, unusual cases, practice management and personal finance, as well as travel and medical humour videos, and much more.

Watch your colleagues' videos and leave them a comment. Upload your favourite videos to share. It's a constantly growing library of videos selected and viewed by people like you. Don't miss the hilarious "" or the stunning footage of an .

Here's a sneak preview of one video, called "Doctor's Fly Swatter," for readers of Canadian Medicine:
Registration is free for health professionals from around the world.

Check it out and tell us what you think at .

See you on !

With ambulances backed up in the parking lot and a crushing overflow of emergency cases, the chief of the emergency department at the largest hospital in the Atlantic provinces triggered a "code orange," or mass casualty, alarm briefly on Tuesday morning. The incident occurred at the Queen Elizabeth II Hospital, in Halifax.

The Canadian Association of Emergency Physicians issued new recommendations on firearms control and gun violence. "More effective gun control must continue to focus on long arms, rural populations and those at risk of suicide or domestic violence," the group said in a release. One of the CAEP's recommendations is "Support for legislation mandating that health care facilities report gun shot wounds, but not knife injuries or other violent injuries." []

Israeli professor of medicine Howard Tendeter, who trained in Canada, wrote about diagnosing his own sleep apnea in the latest Canadian Family Physician: "In 1994 I was 38 years old and completing a fellowship in Canada. Every evening, after a busy day at the clinic, I took the subway to leave downtown Toronto; every evening I fell asleep during the trip and woke up at the final station in the north end of the city. One evening I did not wake up, and I found myself back downtown. Then I said to myself, 'That’s it. It’s time to go for a sleep study.'" [] Co-editor Dr Roger Ladouceur commented sympathetically, "Two years ago, when I went to see Pirates of the Caribbean III with my daughter, I remembered absolutely nothing about it because I slept through the whole thing to her great despair. She kept nudging me, embarrassed that I would disturb the entire audience. But I regularly see people sleeping in the theatre." []

In this week's Canadian Medical Association Journal, Dr Irfan Dhalla reviewed the 2008 book Exploring Social Insurance: Can a Dose of Europe Cure Canadian Health Care Finance? edited by three Canadian health policy experts from the University of Toronto. More information on the book is available from the McGill-Queen's University Press .

Dr Itiel E Dror, senior lecturer in the department of psychology at the University of Southampton, will speak in Toronto on "Why forensic examinations are inherently biased, and what can be done about it" on Friday at 12:30 pm. The event, hosted by Dr Michael Pollanen, the interim director of the University of Toronto Centre for Forensic Science and Medicine. To read about Dr Dror's background, click .

The Institute of Clinical Evaluative Sciences, in partnership with the government of Ontario and the Canadian Institute for Health Information, will hold its Health Care 2009 conference on February 2, in Toronto. []

Canadian Medicine news
Our directory of blogs written by Canadian physicians and medical residents and students -- the largest such database available -- now lists 61 blogs. Check out "CANADIAN MD BLOGS" on the left-hand sidebar or click here to see our directory.

Issues in HIV transmission
Prosecuting people who spread HIV without taking precautions to protect their partners is inadvisable, McGill's Dr Mark Wainberg wrote in a commentary published last month in Retrovirology. "[B]eing potentially charged with wilful HIV transmission may be a significant deterrent to being tested for HIV infection in the first place," he wrote. "After all, an individual who does not know that he is HIV positive cannot logically be accused of its transmission. His opinion that police should not treat such cases as criminal matters, instead leaving the problem to public health officials to deal with, has created some controversy because more than one criminal HIV-transmission case has now come before the courts. "We don't want to stigmatize and, in a way, you are stigmatizing HIV-positive status," Dr Wainberg (above), a world-renowned HIV/AIDS researcher who chaired the 2006 International AIDS Conference in Toronto, told the National Post last week. "We're not doing enough to encourage testing, and decriminalizing transmission would be a step in the right direction." His position has not been endorsed by everyone in the field. "It's beyond the limit, just like it's illegal to bash someone on the head with a stick. It just happens to be a viral stick. But it's a potentially serious assault," said Ontario Epidemiologic Monitoring Unit chief Dr Robert Remis. Barry Adam, of the University of Windsor, has begun work on a study to evaluate the effect of the transmission trials on HIV-positive people.

A novel HIV-transmission prevention program co-designed by University of Western Ontario ob/gyn and psychology professor Bill Fisher -- in which patients and their physicians work together to evaluate the risks of their sexual practices and come up with a "prevention prescription" -- has been included in the US Centers for Disease Control and Prevention's 2008 Compendium of Evidence-Based HIV Prevention Interventions. The program, which Dr Fisher created with his brother, Jeffrey, a professor of psychology at the University of Connecticut and HIV prevention expert, is called Options/Opciones. "At the end of the four or five years of study, we found that HIV transmission risk behaviour by the HIV positive patients who received the Options/Opciones intervention was reduced to almost nothing," said Dr Fisher. []

Mix 'n' match BP drugs pose danger
Combining ACE inhibitors and ARBs causes a rise in potassium levels that can lead to potentially fatal kidney failure, warned the Heart & Stroke Foundation of Canada. "These two popular categories of hypertension medication are each safe and effective treatments - but not together," spokesperson Dr Sheldon Tobe said in a release. "They don’t give any additional benefit in combination but each is associated with side effects so all you do is double up the side effects but you don’t double up the benefits." The warning comes as part of a new set of Canadian Hypertension Education Program treatment guidelines [] drafted in response to the findings of a major international study known as ONTARGET, published last year in the New England Journal of Medicine. The study showed ACE inhibitors and ARBs to be equally effective and reported increased adverse events when the two were combined.

Getting doctors to fess up and say sorry
In the wake of apology protection legislation passed by Manitoba opposition leader Dr Jon Gerrard last year, the Winnipeg Regional Health Authority is encouraging its physicians and staff to apologize to patients if a mistake is made. "People are slowly getting used to the idea that there are lots of preventable injuries and preventable deaths," Rob Robson, the health authority's chief patient safety officer, told Lisa Priest of The Globe and Mail. "And we need to get off our butts and do something about it." Alberta became the latest province to adopt an apology protection law when it passed Bill 30 late last year. [ (PDF)] Provinces with apology protection legislation now include Alberta, Ontario, Manitoba, Saskatchewan and British Columbia. Yukon legislator Don Inverarity attempted to put a bill through the Yukon territorial legislature but it only made it to a second reading last April before being "negativized." Mr Inverarity didn't hold out much hope for his attempt to pass the law when I spoke to him last year. "I don't think it will see the light of day," he said.

Couillard runs into private-sector trouble
Former Quebec Health Minister Dr Philippe Couillard is under investigation by the province's lobbying commissioner to determine whether he had inappropriate contact with unregistered lobbyists before he resigned from politics last year and soon after went to work for a private-sector health investment firm. In the McGill Daily student newspaper, Dr Adam Hoffman and a law graduate, Cory Verbauwhede, took issue with the university's recent appointment of Dr Couillard as a senior fellow in health law. "Legal investigations aside, we feel it is unseemly for an academic institution to hire an individual whose political actions contradicted the prevailing evidence-based policy research," they wrote.

"Why am I depressed?" elicits increasingly complex answer
Dr Aaron T Beck, an influential depression researcher and renowned University of Pennsylvania psychiatry professor, has proposed an updated theory of the nature of depression that incorporates into his earlier cognitive/developmental psychology explanation a new recognition of the role of genetic expression in the disease. The essay by Dr Beck discussed in the Globe's article, "The Evolution of the Cognitive Model of Depression and Its Neurobiological Correlates," was published in the American Journal of Psychiatry in August. "It is now possible," he wrote, "to sketch out possible genetic and neurochemical pathways that interact with or are parallel to cognitive variables... I suggest that comprehensive study of the psychological as well as biological correlates of depression can provide a new understanding of this debilitating disorder."

Elsewhere in Canada...
Dr Daniel Birch, of Edmonton, performed Canada's first robot-assisted gastric bypass surgery.

Vancouver Coastal Health Authority CEO Ida Goodreau quit her job for a new position running LifeLabs, a major private-sector diagnostic laboratory firm. The health authority's perilous financial situation -- its accumulated deficit has grown to $100 million and shows no signs of reversing course -- was reportedly rumoured (at least in part by NDP health critic Adrian Dix) to be the impetus for her departure, but she and Health Minister George Abbott both denied the connection. "I understand people's curiosity about it, but really, it is just a personal career decision," Ms Goodreau said. "Certainly, her departure is in no way connected to the ongoing budget challenges," said Mr Abbott.

A video from CanadianEMR.ca has useful information about speech recognition software for doctors.

Ever wonder what became of former Liberal Health Minister Allan Rock? Now the president of the University of Ottawa, he's letting university students crash at his place downtown during the city's transportation strike. "Debby and I know that the strike is creating enormous stress for students. Some are even being forced to abandon their studies," he said. "We have the space, and we are happy to accommodate two people starting right away." [] What a guy.

News from south of the border
The latest edition of the weekly medical blog anthology Grand Rounds is a special edition on healthcare reform in the US, to mark the inauguration of President Barack Obama.

And, just for fun, check out RateMDs profile.