Canadian Medicine

The HRT debate continues
Postmenopausal hormone replacement therapy (HRT) raises women's risk of developing breast cancer, as first reported in 2002, but that increased risk doesn't appear until after two to three years of HRT, reported American Cancer Society researchers in a new study published online in Cancer.

This study appears to confirm the conclusions of research published last month by the Society of Obstetricians and Gynecologists of Canada that said HRT was safe for short-term use by younger postmenopausal women, reported Forbes. The SOGC research also said that fears of HRT's dangers had been exaggerated by prior research, and that those fears had denied many women the benefits of HRT. "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 said at the time. [Canadian Medicine]

Another new study, this one in the New England Journal of Medicine, found that breast cancer rates declined following the publication of the 2002 Women's Health Initiative study that first warned women of the risks of HRT. This new study was published by the Women's Health Initiative researchers. Although the study does indeed confirm HRT's link to breast cancer, it cannot account for the criticism by the Canadian researchers that HRT's potential dangers vary by age group and that the 2002 Women's Health Initiative study had conflated the risks of older and younger postmenopausal women. The Society of Obstetricians and Gynecologists of Canada told The Globe and Mail's André Picard that the NEJM study does not change their January recommendations.

Simplifying and codifying genetic research
New guidelines designed to standardize the reporting of genetic-association studies were published in seven major medical journals by an international team of some of the world's top human genome researchers, led by Julian Little, the University of Ottawa professor who holds the Canada Research Chair in Human Genome Epidemiology.

Hopefully, Dr Little said in a release, the proposed guidelines will lead to a policy that will make genetic-association research more transparent and more useful. "This is a large field of research which has created a great deal of debate between those who expect genetic information to transform medicine and health, and those who are skeptical," he said. "We hope that this initiative will help specialists and non-specialists alike to figure out the factors in methods that help produce solid evidence on which to use genetic information." []

The guidelines are published in a paper, titled "STrengthening the REporting of Genetic Association studies" or STREGA, intended to organize the way genetic-association research is written, in order to make it easier for researchers to use the research in the future. [ (PDF)]

Granted, that may sound a bit dry -- but when was the last time you can recall a paper being published simultaneously by as impressive a group of journals as the Annals of Internal Medicine, the European Journal of Epidemiology, the European Journal of Clinical Investigation, the Genetic Epidemiology, the Human Genetics, the Journal of Clinical Epidemiology and PLoS Medicine? This is no small matter, obviously.

The guidelines are a proposed framework, but they will be reviewed with the goal of creating policy later this year by the Canadian branch of the Human Genome Epidemiology Network, and comments will be solicited to that end. []

Don't ask, don't tell?
The Alberta Medical Association has asked the provincial government to consult further with the medical community before passing Bill 52, which would allow the health minister to force doctors to enter patients' information into a provincial electronic medical records system.

"If it's going to be located in the electronic medical record, I'm going to have and others are going to have widespread access to it, so patients and their families may not disclose information and that may have an adverse effect on direct patient care," AMA President Dr Christopher Doig told the Edmonton Journal. "A risk is if physicians or even sections of physicians feel that very personal and private information is going to be potentially accessed widespread, they may abandon electronic records and return to other ways of recording information, either paper or simply stopping recording some pieces of information."

The provincial privacy commissioner's office is also concerned about the legislation.

Wonk talk
The latest edition of the health policy blog anthology, the Health Wonk Review, is available.

Photo: Shutterstock

Drug-resistant gonorrhea emerges from "antibiotic soup"
In just four years from 2002 to 2006, the proportion of gonorrhea cases in Canada that were resistant to the class of antibiotics known as quinolones rose by a factor of seven, from 4% to 28%. The rise in quinolone resistance has outpaced even the significant increase in the number of gonorrhea cases detected in Canada over the past ten years.

The new data were reported in this week's issue of the Canadian Medical Association Journal by a team of researchers from Toronto, Ottawa and Winnipeg. []

Quinolone resistance was much more common in patients older than 30 than in younger patients, and more common in men than in women, the researchers reported.

The authors of the study urged doctors to abandon quinolone as therapy for gonorrhea patients, for whom it continues to be prescribed "perhaps because of the convenience, safety and tolerability of quinolones."

In an accompanying commentary [], Dr John Tapsall, an Australian microbiology researcher affiliated with the WHO Collaborating Centre for Sexually Transmitted Diseases, wrote:

"Individual practitioners can make an important contribution to solving the problem. Appropriate use of antibiotics in general is fundamental to the control of drug resistance in all community-acquired pathogens. Familiarity with and adherence to recommended treatment regimens for gonorrhea is also crucial.

"[...] the gonococcus exists in an "antibiotic soup" resulting from general misuse of antibiotics, which subjects the organism to substantial evolutionary pressures. Until these crucial areas are addressed more effectively, all countries will be at risk from the emergence and spread of even more resistant variants of this highly adaptable pathogen."

Lead researcher Dr Susan Richardson told CBC News, "Really there needs to be a Canada-wide surveillance project that is probably ongoing into the future to keep tabs on what's happening to resistance for this important public health pathogen."

Dr Tom Wong, the Public Health Agency of Canada's director of community-acquired infections, said a national surveillance system is in the works. "We are very hopeful that very soon we will have some of the pilot sites up and running. But at this time we are still actually trying to get all of those logistics set up."

Transmission prevention, of course, remains a priority as well. (Hence the great stock photo above.)

Clear the hallways
New Brunswick's chief fire inspector said he often has to remind hospitals not to put patients in the hallways, as the practice violates the province's fire code.

That may sound all well and good, but someone should remind the good inspector about an incident at the Saint John Regional Hospital a year ago when an 86-year-old patient was placed in a shower room overnight because there was no bed for him. If not the hallways, then where will the overflow patients go?

"State your emergency"
The Canadian government telecom regulator will require all cell phone companies to enable their phones to be traced to their location by emergency responders. The change, which comes in response to several highly publicized deaths in cases where callers could not be found quickly, must be made by next year.

IHI comes to Canada
The Institute for Healthcare Improvement's 10th Annuaal International Summit on Redesigning the Clinical Office Practice will be held in Vancouver from March 22 to 24. A $100 early registration discount applies if you register before Saturday. The full price is $895 USD.

Grand Rounds
Radiological imaging blog Not Totally Rad hosts this week's edition of Grand Rounds, the collection of the best writing from the health blogs.

Family resemblance? Not so much
Ontario Health Minister David Caplan's brother, Zane Caplansky, who was also a politician for a time, has abandoned the public service, changed his name back to its original form, and become a smoked meat sandwich vendor in Toronto. That may not be quite as healthy a contribution to the public as his brother's cabinet position, but it's sure hard to condemn a good smoked meat sandwich.

Water wars
Residents of Shannon, Quebec, a town north of Quebec City, have begun a class-action lawsuit against the federal government and other groups over accusations that a chemical called trichloroethylene, or TCE, seeped into the town's water supply from a nearby military base and caused a spike in cancers.

At a news conference last Friday, one lawyer representing the 2,000 or so claimants from Shannon (its bridge is pictured to the right) presented new evidence from a molecular toxicology study that he said demonstrated a direct link between TCE and genetic mutations that cause cancer.

In response, Quebec Health Minister Dr Yves Bolduc asked public health officials to assess whether it is possible to conduct a full epidemiological study of the town to determine the effect the chemical had. "[I want] to see what is possible to support the community," he said.

"A lot of people on that military base got cancer," lawyer Stephen Clarke told The Globe and Mail. "So it's bigger than just a lawsuit. It's really a deep wound to the heart of small-town Canada."

A new discipline
McGill University created a research chair in psychosocial oncology, to study the psychology issues related to cancer care. "While cancer is the leading cause of premature death in this country, historical data show that more and more people are surviving each year,” said the dean of medicine, Dr Richard Levin. “A chair in psychosocial oncology supports an expanded and interdisciplinary approach to cancer care that focuses on improving quality of life." []

Controversial lessons from New Zealand
British Columbia ministry of health officials travelled to New Zealand last year to study the country's healthcare system and report back on ways to improve the way the BC system operates. What did they learn? Well, New Zealand's system relies in part on relatively small co-pays, or what are typically called "user fees" in Canada, for funding, but that idea is probably not only politically unpalatable here but also illegal under the Canada Health Act. []

Whew!
Genome Canada will receive federal funding, after all. According to Public Works Minister Christina Paradis, the panic that followed the omission of any mentin of the research organization in the federal government's new budget was caused by a bit of confusion.

Two new hospitals in BC
The Vancouver Island Health Authority announced plans to build two new hospitals, in Comox and Campbell River, at a cost of up to $600 million. "They have to be more specific than that," said Dr Aref Tabarsi, a spokesperson for the Campbell River Medical Staff, of the broadly outlined new hospital plan. "Cancer care - what do they mean by cancer care? We are taking care of cancer patients here, too. This is actually very suspicious... and to tell you the truth we are actually very disappointed it took them a year to come up with a plan that has hardly any detail in it."

The Campbell River Mirror editorial board declared themselves "suspicious" of the new plan, agreeing with Dr Tabarsi.

International attention on ethics
Dr Kevin Patterson's admission that he violated medical ethics guidelines by publishing the name of a dead patient he treated in Afghanistan ha caught the attention of the New York Times. "The ruling, which followed a complaint from the Canadian Armed Forces, has raised questions about privacy rights of the dead and the military’s efforts to control coverage of the war," the newspaper reported. Read Canadian Medicine's coverage .

Politesse
Can you teach bedside manner? Yes, wrote Dr Pauline Chen.