Canadian Medicine

Manitoba First Nations declare H1N1 flu emergency
Chiefs of Manitoba First Nations have declared a state of emergency as the H1N1 flu pandemic ravages their already-troubled communities.

The chiefs lay the blame for the virus's quick spread on the federal and provincial governments, whom they say failed to act early enough.

"No one is taking responsibility," David Harper, of the Garden Hill First Nation, told the Winnipeg Sun. "We've crossed the line. We've had enough."

One point of contention is that deliveries of hand sanitizer were delayed because of concerns that the alcohol-based gels would be abused by First Nations patients trying to get drunk. A government official confirmed the reason for the delays. "The discussion was with the best interests of our clients in mind," Anne-Marie Robinson, the assistant deputy minister of the First Nations and Inuit Health Branch of the federal health ministry. "We have had some rare experiences in our communities where we have had theft of hand sanitizers. … We do have communities where we have large proportions of people who suffer from addiction. … We have had a number of people come forward, and some evidence, where this could potentially put people at risk."

The delivery took two and half weeks to arrive, while the flu was making its way through the towns. []

First Nations have higher infant mortality, TB rates
Canadian First Nations peoples have higher infant mortality and tuberculosis infection rates than the rest of the Canadian population, a new UNICEF Canada study showed.

More news from across Canada

- Quebec appeared poised to abandon its public-private partnership plans for the construction of the forthcoming Montreal mega-hospitals. [La Presse]

- Newfoundland MDs demanded higher pay in their next agreement with the provincial government.

- A Canadian HIV expert prepared to begin an innovative new study that might lead to treatments that could not only suppress the virus's ability to reproduce but actually eliminate it from the body completely.

- Knee and hip joint surgeries, though they are expensive, actually save the public healthcare system money in the long run. (No pun intended.) []

- The burden of chronic diseases presents a challenge particularly for women, who are now living longer than ever before. So says a new study from St Michael's Hospital and the Institute for Clinical Evaluative Sciences, in Toronto. []

- The Coalition of Family Physicians of Ontario, a doctors' group that tends to oppose the Ontario Medical Association and the provincial government in part because they inhibit doctors' freedom to practise as they wish, pointed to a recent essay by health law experts Lonny Rosen and Elyse Sunshine that concluded "concern remains that doctors will find themselves embroiled in more conflicts and other proceedings as a result of the College's enhanced investigative powers and the increased information disclosure required by the new amendments." The laws were passed as part of a major health regulatory reform package known as Bill 141, back in April. [Canadian Medicine]

- Some MDs are concerned about a recent British Columbia law that permits naturopaths to do allergy testing. The Canadian Society of Allergy and Clinical Immunology, the British Columbia Medical Association and other groups have expressed their worries to the health minister.

- The Supreme Court gave its okay to governments' practice of forcing Jehovah's Witness minors to receive blood transfusions if deemed medically necessary. However, the court's decision made clear that judges should use their discretion to determine whether the minor is capable of making a responsible decision before enforcing a transfusion.

- A drug called aprepitant was found to reduce chemo-induced nausea and vomiting. The new evidence was presented at the Multinational Association of Supportive Care in Cancer, in Rome, yesterday. It has not yet been published in a peer-reviewed journal. []

- Alcohol is linked to one in 25 deaths worldwide, reported researchers from Toronto's Centre for Addictions and Mental Health. []

- A Saskatchewan doctor was fined for refusing to report to the hospital when he was on call and for attempting to treat himself at the hospital.

- A Winnipeg Children's Hospital doctor was charged with child sex abuse.

- The government of Canada passed regulations banning the sale of plastic baby bottles containing the chemical bisphenol A (BPA). "Our Government is acting to protect its most vulnerable citizens-newborns and infants," Health Minister Leona Aglukkaq said in a release. "Canada is the first country to move ahead with regulations to prohibit polycarbonate baby bottles that contain bisphenol A. We want parents to feel confident that they can safely bottle-feed their newborns and infants." [] Why has no other country acted yet? Because there's no firm evidence that bisphenol A is actually dangerous, wrote Terence Corcoran.

- You may soon be seeing fewer vaccine ads. (The fact you see any at all in Canada is because vaccines are not covered under the ban on direct-to-consumer drug advertising.) In response to complaints, Health Canada is demanding drug companies insert more safety information into their advertising material.

- Health Canada, in issuing a health advisory warning consumers of the dangers of reusable cloth shopping bags and the bacteria and mould they could potentially collect, has effectively backed the plastics industry. [] Who underwrote the "study" that alerted the public to the health risks that could theoretically arise from the contaminated cloth bags? Why, it was the plastics industry!

- Dr PC Adams, published in the Canadian Journal of Gastroenterology an essay titled "The impact of cirrhosis on the history of jazz." [ (free full-length PDF available)]

- Canadian blogger and new family practice resident Dr Ottematic contemplated joining the Canadian Forces for the great salary and the medical training, but decided (for the time being at least) not to enlist.

- Kevin Megeney, the Nova Scotia soldier killed inside a NATO base in Afghanistan in 2007, was shot by a fellow soldier while they played a game of "quick draw," alleged crown prosecutors. After he was shot, Mr Megeney was treated by a civilian physician on contract with the military named Kevin Patterson, from BC. Dr Patterson went on to publish a graphic account of the episode in an excellent article he wrote for the American political magazine Mother Jones. Dr Patterson later conceded that published Mr Megeney's name was unethical and agreed to donate his earnings from the article to charity and pay a fine to the BC College of Physicians and Surgeons. [Canadian Medicine]

- This week's Health Wonk Review includes a whole section devoted to Canada. In it are articles by blogger The Ismological [""] and by Canadian Medicine.

NB replaces health minister in midst of crisis
After a calamitous and bruising weeks-long battle with the province's physicians, New Brunswick Health Minister Mike Murphy has been removed from the health ministry and sent to run the justice department.

Mary Schryer (left) has been named the new health minister.

Of course, that's hardly a demotion or a sign that Premier Shawn Graham is going to reverse the decision that precipitated the fight with the doctors -- the government's recent recession-influenced decision not to honour the agreement on raises it came to with the doctors' union last year -- and it appears so far that Mr Murphy's departure is unlikely to change the situation. But the appointment of a new health minister is at the very least a sign that Mr Graham and perhaps even Mr Murphy as well recognized that Mr Murphy's relationship with the medical community was irrecoverably damaged.

"Michael Murphy's departure from the Department of Health is welcome," commented the Telegraph-Journal. "A lawyer by profession and debater by temperament, he was never suited for a portfolio that must be above partisan politics. It's not surprising that his most prominent reforms have drawn threats of legal challenge." As for Mr Schryer, the newspaper remarked, "She'll have her hands full trying to re-open negotiations with physicians, address the doctor shortage, and bring order to a health system so overloaded that patients are being housed in shower stalls."

Ms Schryer was a financial planner and a director on the board of the Atlantic Health Sciences Corporation before entering politics.

But while Mr Murphy's exit from the health portfolio might be seen as a positive development in what must inevitably be some variety of reconciliation between doctors and the government, there's no guarantee that as justice minister he will be, as the Daily Gleaner put it, be "in less of a position to trample all over people the way he did with the doctors' wage freeze fiasco." The reason for that is because there is a strong possibility that he could end up directly involved with the doctors once again, since the New Brunswick Medical Society has now threatened to take the government to court over its decision to break the deal it had promised to the society last year.

Perhaps it will not come to that, however. Mr Graham appears to have gradually come to realize the folly of angering nearly the entire medical profession in one fell swoop and he has made some initial overtures to the medical society, saying he would like to reopen negotiations. So far, the NBMS has refused to return to the table.

But Bill 93, the legislation essentially authorizing the government to ignore the commitment it made last year, has indeed been passed by parliament but it has not been proclaimed yet, leaving open some potential room for Mr Graham and Ms Schryer to maneuver.

Nova Scotia also gets new health minister
New NDP premier Darrell Dexter named Maureen MacDonald the province's health minister. [] Ms MacDonald was a social work professor at Dalhousie before entering politics. She also worked as a community health educator, a legal aid worker, and a journalist.

Just before Ms MacDonald's name was announced, the Chronicle Herald's Ralph Surette penned a column with his advice for the new minister. He advised her, "you don’t have to overhaul the general policy direction... Indeed, the only policy challenge you have is to reverse your party’s crazy promise to keep all rural ERs open all the time. In order to keep that vow, you’d have to strip the primary care system of doctors, pay doctors more than they make in their offices to staff ERs overnight, when in fact there’s very little business and the ambulances take real emergencies elsewhere. This is not just bad policy, it’s nuts. You’d be paying doctors a fortune for basically doing nothing."

Former health minister Karen Casey, meanwhile, took over as interim PC leader as defeated premier Rodney MacDonald stepped down.

Ontario opts not to replace health minister
In a move that surprised some in Ontario, Premier Dalton McGuinty shuffled his cabinet slightly but chose not to appoint a new health minister to replace the embattled David Caplan, who has been under fire from opposition members for several weeks in relation to the untendered contracts handed out by the eHealth Ontario agency.

BC health minister still getting acclimated
BC Health Minister Kevin Falcon, who has only been on the job for about two weeks since being switched over from the ministry of transportation, offered a rather confused analysis of public-private balance before calling a Vancouver Sun reporter back to explain himself. Our guess: don't read too much into this exchange. We figure Mr Falcon was just trying to keep up with an experienced reporter and let his mouth get ahead of his brain. It's doubtful he was forming new policy on the fly.

In a new article, Canadian Healthcare Technology wondered if new Mr Falcon will opt for the same kind of de-regionalization, or at least a limited variant thereof, that Alberta and New Brunswick have experimented with in recent years.

The New Brunswick government followed through on Health Minister Mike Murphy's (left) threats and, last Thursday, passed Bill 93, effectively eliminating the wage increases the province's physicians had been promised in negotiations last year. [ (PDF)]

The New Brunswick Medical Society's reaction was -- not surprisingly -- one of disappointment but not surprise. Society president Dr Ludget Blier (right) issued a statement condemning the government and making clear that physicians don't intend to take this provocation lightly. In other words: you'll be hearing from their lawyers, Mr Murphy. Dr Blier's statement is so strongly worded that it's worth reading in full:

If there was any remaining doubt about the level of respect that the Shawn Graham government has for New Brunswick doctors, it was wiped out on June 18, 2009 with the third reading of Bill 93. This historic piece of legislation will render a duly negotiated and ratified agreement to be "null and void", and will attempt to block any efforts to challenge that decree.

The president of the New Brunswick Medical Society, Dr. Ludger Blier, says that it is difficult to find words that are strong enough to express how he and his fellow physicians feel about how they have been treated over the past eighteen months or more. "Used and abused are words that come to mind", says Dr. Blier. "We spent many days, weeks and months across the negotiating table from government representatives before finally signing off, page by page, on the terms for new agreements. We placed those terms in front of our membership for a vote, with a recommendation that they accept them. Our membership respected the results of the negotiations process. Government did not."

Dr. Blier underlined once again that the decision to single out physicians and walk away from signed agreements was enough to seriously damage the relationship between physicians and the Graham government. The way that the Government chose to do that has reinforced the conclusion reached by the doctors, that the only remaining avenue for efforts to salvage the agreements is through the courts.

"We met with the Premier on March 11th at which time he told us that we had choices about how to participate in the government's restraint policy and that the 'negotiating process would be respected' if that was our choice. The Premier subsequently said that we misunderstood and were never given a choice." Dr. Blier points to a document that was given to the Premier on March 19th and letters that were sent to government on April 6th and April 23rd, as evidence of the Society's contention that there was a choice.

"The Premier has invited physicians to return to the negotiating table but only if we agree in advance that the government's policy of two years of "0" would be up front", says Dr. Blier. "Is that a true negotiation, or an attempt to bring some legitimacy to unacceptable behaviour?"

Dr. Blier says that the Medical Society will continue to pursue what legal options are open to physicians to protect the duly negotiated agreements.

For more on the ongoing battle between the government of New Brunswick and the province's doctors, read Canadian Medicine's previous coverage of doctors' threats to strike and campaign against the Liberals and our coverage of the recession-induced origins of the government's decision to rescind its offer of raises to the doctors.