Canadian Medicine

Gov't funds free-heroin clinic in Vancouver
Health Canada gave its approval to a research clinic in Vancouver that goes well beyond the mandate of the controversial safe-injection Insite clinic: this new one will distribute free heroin to addicts. The research project is called SALOME and is a follow-up to NAOMI. []

In related news, the Ontario Press Council dismissed a complaint made by Drs Thomas Kerr and Evan Wood -- two BC scholars who have been among the leading researchers in the world on the effects safe-injection clinics have on HIV/AIDS rates -- against The Globe and Mail for a column by Margaret Wente that they felt impugned their reputations as researchers.

Quebec will re-do 2100 breast cancer pathology tests
Acting on the recommendation of a committee of medical experts, Quebec Health Minister Dr Yves Bolduc announced on Thursday that 2,100 breast cancer pathology tests would have to be re-analyzed to ensure no errors are adversely affecting patients' treatment. The committee was formed in response to a study issued by the Quebec Association of Pathologists that found very high error rates in breast cancer pathology tests. []

Isotope shortage gets political
Natural Resources Minister Lisa Raitt took a shot at the federal opposition this week when she said that, because foreign suppliers will be able to fill Canadian demand for radioisotopes while the Chalk River nuclear plant is shut down, there is no need to overreact. "I think it's incredibly important that we don't have fear mongering for people in Canada with respect to this issue," she told a House of Commons committee investigating the radioisotope shortage.

Little did she know at the time she'd soon be on the defensive. One of Ms Raitt's aides had left behind secret documents showing undisclosed spending on Chalk River at the offices of CTV News the week before, the news organization reported. Surely thinking back to the incident that forced Maxime Bernier to step down from cabinet, Ms Raitt offered Prime Minister Stephen Harper her resignation but he declined it. The aide responsible for the documents, however, was fired. []

Liberal leader Michael Ignatieff, surely sensing an opportunity for political gain, hinted that the Chalk River shutdown could become an election issue, while some journalists have been talking about the possibility of a summer or fall federal election.

A quick round-up of more recent health news
An international team of researchers, including Canadians, found that the HPV vaccine Gardasil offers at least eight years of protection against the virus. []

Quebec announced a universal newborn hearing screening program. []

The first class of doctors has graduated from the Northern Ontario School of Medicine.

A Montreal man was forced to deliver his baby in the Royal Victoria hospital in downtown Montreal without help from nurses or physicians. "The nurse did come by our room twice but didn't really come in but just stood at the door and said, 'I'll be there in a few minutes, I'll be there in a few minutes,'" said the father. "I just put my hand on his chest, and my fingers around his armpits, and my other hand kind of on his face …and I just pulled him out."

Privacy-law confusion may harm health research, reported a new Canadian study.

There's less than one week left until the . Current polls have the NDP poised to form a government, forcing the incumbent Progressive Conservatives into opposition.

But, of course, the results are not decided until the last ballot is counted. So for doctors and patients alike who are still unsure of how they are going to vote, Doctors Nova Scotia has put together a that includes not only the medical association's position on five important health policy topics (physician recruitment, emergency care, long-term care, healthy living, and electronic medical records) but also the positions of the Tories, the NDP and the Liberals on those topics, to help voters discern where the parties stand.

Layton pitches health reform in US
NDP leader Jack Layton is in Washington, DC, this week to talk to Obama administration officials and American audiences about how to implement a universal healthcare system. "We know the Americans can't just simply adopt our model, walk it across the border and put it in place," he said. "But the principles of universality, of access and of insuring that health care's available to everybody, those kinds of principles are very much motivating the Obama administration."

American adoption of universal healthcare would dissuade some of Canada's healthcare critics, like former CMA president Dr Brian Day, said Mr Layton (left). "If Obama succeeds, it helps us hang onto our public health care system because they're [proponents of privatization] always chipping away at it, trying to say that we need to privatize." []

Update, Wednesday, June 3: You can read the full text of Mr Layton's speech this morning at the Woodrow Wilson Centre .

Review Quebec breast cancer test errors: critics
Quebec Health Minister Dr Yves Bolduc last week tried to dismiss concerns that a new study by the Quebec Association of Pathologists proved that high test error rates meant that tests would have to be re-done. [Canadian Medicine]

Dr Bolduc began this week trying to play down the implications of the study and saying the story had been blown out of proportion when other medical experts suggested thousands of tests might need to be repeated. "That is totally false," he said.

Dr Bolduc said reporters had misinterpreted the study. "The experts have concluded that it is not true to say that a variation observed in the results in terms of quality means that there is the same variation in terms of wrong tests or inappropriate treatment." He also blasted Dr Gaétan Barrette, the president of the Federation of Medical Specialists of Quebec union, who had suggested the error rates were the result of government mismanagement of the healthcare system. "He's speaking for a union, he does not represent any professional association of quality," Dr Bolduc said. "You have to look at his credibility in that context." Dr Barrette told CBC News that Dr Bolduc's criticism was "outrageous." "Where did he do his medical training?" fumed Dr Barrette. He must have forgotten. Dr Bolduc received his MD from Université Laval, class of 1981.

But despite Dr Bolduc's pleas for calm, the controversy has grown. On Monday, the provincial College of Physicians and Surgeons called for a committee of experts to be set up to investigate the proper course of action. [] On Tuesday, Dr Bolduc not only acquiesced but also announced that pathology tests would hereby be subjected to quality assurance, which they had not all been previously. [] The committee will make recommendations to him at the end of the week.

Things are looking grim for Dr Bolduc now. One of the Quebec Association of Pathologists researchers said some cancer tests will have to be repeated. [] And the opposition ADQ party is calling for Bolduc to resign because of this issue as well as prior problems it cited. [] Dr Amir Khadir, a Montreal infectious diseases specialist elected to the National Assembly last year, called on Dr Bolduc to stop delaying and confusing the public and instead get down to work right away to get to the bottom of the issue. []

Isotope shortage begins to affect patients
Reports from across Canada tell of the test delays and cancellations doctors have been forced to make as a result of the radioisotope shortage caused by the shutdown for safety repairs at the Chalk River nuclear plant in eastern Ontario. The shortage is affecting doctors and their patients in , , , , and elsewhere, and delayed exams are all but certain to be the norm in many regions.

The political fallout (please forgive the pun) from the Chalk River shutdown has continued to accumulate.

An editorial in the Toronto Star pointed out the contradictions inherent in the government's vastly different responses to the 2007 and the current Chalk River shutdowns. The 2007 shutdown, for three weeks, prompted the government to pass emergency legislation to permit the plant to open without the safety repairs that were recommended. Natural Resources Minister Gary Lunn said, "Had we not acted, people invariably would have died, since medical isotopes for serious cancer procedures were not available, and we could not let that happen." Now, with a minimum of three months of down time at Chalk River, Health Minister Leona Aglukkaq has said, "It's not a crisis." The Star concluded, "Stephen Harper's Conservative government is either dramatically underplaying the current medical isotope crisis or wildly overplayed the last one."

Trouble follows eHealth Ontario spending spree
Both opposition parties are calling for Ontario Health Minister David Caplan's resignation after revelations of profligate spending by the government's agency responsible for electronic health records, eHealth Ontario.

It came to light recently that the agency's CEO, Sarah Kramer, handed out $4.8 million in "sole-sourced" contracts, or contracts that were not opened up for bidding.

Subsequently, other expenses incurred at the agency became known. Ms Kramer's $380,000 salary; her $114,000 bonus; her $1,700/day executive assistant; $300/hour consultants who read newspaper articles, reviewed Ms Kramer's holiday voicemail greeting, and briefed her as she rode on the subway.

Sharing in the populist anger, the Toronto Star discovered expense claims for a $3.19 "dessert square" and a $1.65 Tim Hortons tea made by an eHealth consultant who was being paid $2,700/day.

Interim Tory leader Bob Runciman called eHealth a "rogue agency out of control." []

In response to the criticism, eHealth Ontario has hired an independent consulting firm to perform an audit of its spending. []

Hey, doctors: don't discriminate
In the current issue of the College of Physicians and Surgeons of Nova Scotia's quarterly magazine ALERT, the regulatory body reported an instance in which a physician allegedly refused to treat a pregnant patient because she had opted to take advantage of the recently introduced publicly funded midwifery system. Something is seriously wrong when regulators have to remind doctors, "Patients who are considering or who have chosen the services of a midwife expect and deserve to be treated in a non-discriminatory manner by their physicians." []

Straining credulity
A very modern disease: cell-phone elbow.

No one, it seems, is immune from the havoc the current recession is wreaking on the economy. Medicine is sometimes called "recession-proof" but when physicians are paid by the government, as they are in Canada, shrinking government revenues mean that the state's rapidly emptying coffers affect doctors much as they do civil servants.

Facing budget shortfalls, New Brunswick Health Minister Mike Murphy has asked the province's doctors to set aside the two-year contract they agreed on with the government last year and instead accept a two-year wage freeze. The government hasn't signed the agreement and may refuse to pay the doctors' raises regardless of the medical society's response to the minister's pleas.

Setting aside the raises would save the province's health system $36 million, Mr Murphy said. If that money isn't saved on doctors' pay, he said, it will have to come from cutbacks somewhere else. "If we were to turn the tentative agreement into a full agreement, we undoubtably would have to close down hospitals and shut down programs. Then the question is, where would we do that?"

Progressive Conservative health critic Margaret-Ann Blaney accused the government of negotiating in bad faith last year. "They have sabotaged this process from day one," said Ms Blaney. "They have shown the doctors no respect."

Saint John Medical Society president Dr David Iles was pessimistic that physicians could stop the government from imposing its will. "We can ask for binding arbitration, but likely the government will legislate the freeze," he told the Telegraph-Journal. "If you look across the country, no other provincial government has imposed a freeze on doctors so they continue to have raises in salaries... Just to stay competitive across the nation, you need to at least honour our contract. Our salaried docs are well behind other doctors in the region."

New Brunswick doctors will simply leave the province if pay is frozen, said Dr Don Craig, the president of one of the province's medical staff organizations. "A loud sucking sound will hit the east and away we go."

Mr Murphy, meanwhile, has apparently set out to make the province's physicians look like the bad guys. "There are patients of physicians in this province who are undoubtedly suffering some angst over the economy and the inability, sometimes, to pay the mortgage or pay for their children," he said in the legislature last week, implying the doctors shouldn't complain about their high pay. "We are looking for the co-operation of the medical society's members for merely 10 more months so that we can meet a common goal of restraint."