Canadian Medicine

European adventure is over
Canadian Medical Association President Dr Robert Ouellet (right) is back from his European sojourn and ready to draft a "made in Canada" healthcare plan based on his observations from the UK, the Netherlands, Denmark, France and Belgium, which all employ more private insurance and private delivery of care than Canada does. Dr Ouellet said, "Europeans face short, or no, wait times, yet spend less money on health care than Canada." []

Dr Ouellet also mentioned his desire to see a junk food tax enacted in Canada.

The Canadian Health Coalition's Michael McBane said Dr Ouellet was "cherry-picking" aspects of the European systems that fit his objectives. "He wants a Swedish health care system on American tax rates," Mr McBane told the National Post. "That's completely disingenuous. I would argue it's intellectually dishonest."

Linda Silas, the president of the Canadian Federation of Nurses Unions, wrote to the Post to say that innovative practices can be developed here without adopting a European-style system. "A tour of different facilities in Canada will show how wait lists can be eliminated."

"Rather than focus on privatization, perhaps Dr. Ouellet should look more closely at how European nations have improved their public, non-profit systems to benefit patients," said Dr Chris Mackie, a member of the Canadian Doctors for Medicare board, in a release. "We can learn a lot from countries that pay for prescription drugs and dental care. We should also study how other countries have managed to implement electronic health records and nurse-led primary care clinics. The focus on privatization -- not surprising given Dr. Ouellet's history as an owner of a chain of private radiology centres -- is an unfortunate bias that distracts us from the innovations we need to make within Medicare."

Budget brain drain fears
The 2009 federal budget's failure to increase direct funding for scientific research could contribute to a brain drain away from Canada, warned University of Western Ontario VP-Research Ted Hewitt.

"We are building the labs, we are building the offices... and we have top people at Western and certainly elsewhere who are ready, willing and able to do world-class research. But, they desperately need the operating funding to help pay for grad students, for research assistants, to pay for technicians and the basic laboratory supplies." []

Killing cancer
McGill researchers proposed a novel method of "starving" tumours by cutting off the blood supply. [ (PDF)]

Using a potential antithrombotic drug called Diannexin, the researchers managed to prevent mice's tumours from growing. "The molecule we used is effective both in vitro and in vivo. It prevents the formation of new blood vessels in mice with cancer and therefore strongly inhibits tumour growth," said Dr Janusz Rak. []

Gene attack
A particular genetic profile indicates a 2.25-times higher risk of suffering a heart attack, according to a new study published by a team of Canadian and British researchers led by McMaster University professor Dr Sonia Anand.

"The unique contribution of our study is that we demonstrate that common genetic variants are indeed common across 5 ethnic groups," said Dr Anand in a release. "Furthermore, we are able to put the contribution of these factors on the risk of heart attack into perspective, demonstrating that the nine risk factors account for the vast majority of heart attacks and the genetic variants while important only add a small independent contribution to the risk of heart attack." []

There's something fishy about Newfoundland research
One of the hippest trends in health research and other scientific research these days is "knowledge mobilization" -- getting research findings to clinicians in the trenches.

Memorial University today announced a new knowledge mobilization initiative, an online portal intended to increase accessibility to the school's research, named . Memorial University news release

Acting school president Eddy Campbell called the oddly named project "Newfoundland and Labrador's answer to Google, and a cause for celebration," according to the Voice of the Common Man, a Newfoundland AM radio news station (590 on your dial).

Yaffle, which will connect Newfoundland residents with information about medical and scientific research going on in their communities, is named after a word found in the Dictionary of Newfoundland English that means "."

That's not the only definition for the term, though. It can also be used as a verb, as in ""; to refer to someone who , as British poet Peter Reading ; as a ; or, perhaps, as a word meaning "."


Photo: Liam Maloney, National Review of Medicine

The number of cancer cases in Fort Chipewyan, Alberta, is unusually high, found a government-commissioned study carried out by researchers from the Alberta Cancer Board released this month.

But the study was not able to identify what was responsible for the increased rates, much to the frustration of the residents of the town -- a small First Nations community downriver from the oilsands developments (pictured right).

Fort Chip residents, as well as its former family physician, Dr John O'Connor, have long insisted that toxic run-off from the oilsands projects had contaminated the town's water supply and caused a spike in cancer rates. Dr O'Connor reported six cases of cholangiocarcinoma, a type of bile duct cancer, but the Cancer Board's report could confirm only two cases of the diease. As a result of Dr O'Connor's public warning about what he believed at the time to be the town's increased rate of cholangiocarcinomas, the federal Ministry of Health filed a complaint with Alberta's medical regulatory body accusing Dr O'Connor of acting unprofessionally and inciting undue alarm.

So now that the Alberta Cancer Board study has confirmed there is indeed an unusually high cancer rate (albeit not cholangiocarcinomas) is Dr O'Connor vindicated? Not entirely.

The (PDF) suggested several possible causes:

1. Chance. "Any search for a cancer cluster is likely to find some aggregation of cases in a geographic location or over a period of time, even if there is no causal explanation... The selection of the study area and the calendar time period was strongly influenced by the community physician’s report of an increase in cancer cases since 2000. As a result, our analysis would have an increased probability of finding a higher than expected number of cancer cases in the community as a result of a phenomenon termed the 'Texas-sharp shooter fallacy'. This is named for the anecdotal Texan who fired his gun randomly at the side of a barn, then drew a target around the spot where most of the bullet holes clustered and claimed to be a sharpshooter."
   
2. Increased detection. "Dr. O’Connor, the community physician who initially raised concern about the possible excess in cancer risk began working in Fort Chipewyan in 2000. Since then, there have been more visits by the community physician, increasing from approximately one visit in two months to every other week... It is possible that previous cases of cancer might not have been detected before the patient moved from the area or died from other causes, or that deaths from cancer might have been attributed to other causes.
   
3. Increased risk. Besides aberrations in demographics, which the researchers accounted for already in their initial calculation of the expected cancer rate, "[t]here are many other factors, however, that can also contribute to variations in risk, such as socio-economic factors, lifestyle, nutrition, as well as factors related to occupational and environmental exposure. These factors may contribute to the differences in cancer incidence found between Fort Chipewyan and the rest of Alberta, but we were not able to measure them in the current study."

The study showed a rise in cancer incidence from 2000-2006 as compared to the first five years of the study, leading them to conclude that their findings "warrant closer monitoring of cancer occurrences in Fort Chipewyan in the coming years."

"The overall findings show there's no cause for alarm, but they do warrant further investigation," Dr Tony Fields, vice-president of the Cancer Corridor, Alberta Health Services, to the Edmonton Sun. "This is 51 cases of cancer over 12 years. It's not huge."

Dr O'Connor, however, disagreed that the study is no cause for alarm. "If I were living in Fort Chip I'd be very alarmed," he .

George Poitras, of the Mikisew Cree First Nation in Fort Chipewyan, , "It's about time that we're getting these results confirming what we've been saying all along."

But Chief Roxanne Marcel wasn't so sanguine. "The study still leaves a lot of questions for us," she the Edmonton Sun. Obviously they didn't conduct a thorough, really good study."

Dr Fields maintains the study was fine. "We are confident the study is sound,” he . “Seldom does a scientific study answer all our questions. Instead, research often points us to where we need to look next. Working with the community we will take those next steps to finding answers.”

Other aboriginal health advocates they too were frustrated by the report's failure to identify a cause for the increased cancer rates.

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