Canadian Medicine

THE INTERVIEW: Dr Bonnie Henry, H1N1 flu fighter

noreply@blogger.com (Sam Solomon) — Mon, 09 Nov 2009 05:00:00 +0000

In this month's issue of Parkhurst Exchange, which should be arriving on physicians' desks across the country right about now, you'll find a short Q&A with Dr Bonnie Henry (right), the BC Centre for Disease Control’s director of Public Health Emergency Management the author of the new book Soap and Water & Common Sense: The Definitive Guide to Viruses, Bacteria, Parasites, and Disease (Anansi).

Online, you can read the full version of the interview, in which we discuss the severity of this pandemic, the steps family physicians can take to make their waiting rooms safer, special billing codes for H1N1 flu consults, and the interesting and pertinent story behind how Canada decided to manufacture its own vaccines after the 1976 swine flu, among other things.

Click here to read the full interview.

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Canada is looking out for your health

noreply@blogger.com (Sam Solomon) — Thu, 05 Nov 2009 20:26:00 +0000

A selection of our favourite Canadian health advisories issued over the last few days.

Solubilize, nebulize, die
When treating H1N1 flu patients, don't solubilize and then nebulize your powdered zanamivir (Relenza) and then put it in a ventilator. A pregnant woman died when the lactose in the powdered zanamivir combined with the liquid used to dissolve the powder and blocked her ventilator.

You'll need a miracle, inshallah
Muslim pilgrims should be vaccinated against influenza and other infectious diseases at least six weeks prior to the Hajj. The warning was issued four weeks before the beginning of the Hajj, which this year occurs November 25-30.

(But perhaps all is not lost. Some supremely strange Islamic websites interpret the word "ma'arej" from the Qu'ran to mean "wormholes" and assert that Mohammed and his angels may have used them to travel through time. So maybe you're not out of luck after all.)

"Consumable entertainment"
You may not be surprised to learn that consuming energy drinks called Mind Strike, Fearocity, Elixir of Tenacity and Power Pulse (right), made by a company called Chaotic Beverages, pose a health risk to children.

The company will certainly be shocked to hear this, considering the drinks were launched in Canada earlier this year in partnership with a company called 4Kids Entertainment, based on a children's card game (a 4-pack of the drinks came packaged with a set of the cards) and animated TV show, and were intended for children : "Fueled with natural energy from green tea extract, and loaded with vitamins, antioxidants and functional herbs, Chaotic Beverages offer kids a great tasting, healthier alternative, beverage that provides a convenient way to meet their hydration needs." (Functional herbs? Alternative to what? More convenient than, say, water? That sentence raises far more questions than it answers.)

The drinks' marketing consultants, U & Me Marketing, saw the product as so revolutionary that they invented a new classification to describe it: "Consumable Entertainment." Health Canada, it seems, wasn't amused.

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What's in the news: Nov. 4 -- Newfoundland's first H1N1 flu death, and more

noreply@blogger.com (Sam Solomon) — Wed, 04 Nov 2009 05:00:00 +0000

H1N1 flu news
Newfoundland and Labrador saw its first H1N1-flu death over the weekend. [St John's Telegram] [Halifax Chronicle-Herald]

Ontario's health minister, Deb Matthews, was surprisingly blunt in blaming municipal planning in Toronto for the city's slow start to the vaccination campaign, calling the work "simply unacceptable." City officials, predictably, were displeased with her assessment. [Toronto Sun]

Several PEI schools are suffering H1N1 flu outbreaks, and nearly half of students are absent from class in one school. [Charlottetown Guardian]

Nova Scotia's government announced it will cover the cost of Tamiflu prescriptions for all residents, regardless of their private pharmaceutical insurance coverage. [Halifax Chronicle-Herald]

An immunization campaign is underway in Ontario prisons, where the H1N1 flu has already appeared, but only inmates are being vaccinated. Guards in an Etobicoke jail staged a brief strike in protest. [Toronto Sun]

The federal agency Public Safety Canada, which has a central role in coordinating the nation's pandemic response, is still not fully functional despite years of planning, Auditor General Sheila Fraser charged. [Canadian Press]

Relying on just one vaccine manufacturer, GlaxoSmithKline, to make all of the country's H1N1 flu vaccine is a decision that should be studied after this pandemic passes to determine whether it was the best course of action, federal health officials said. [Toronto Star]

Two women got into a fight on a New York City subway car when one accused the other of endangering others by not coughing into her hand. [Business Insider]

Clorox and other companies are making a (figurative) killing on products related to the H1N1 flu pandemic. [Globe and Mail]

The Canadian Medical Protective Association, which is the legal defense fund of the country's physicians, speculated that if the H1N1 flu pandemic worsens "retired physicians, physicians who are in Canada but are unlicensed, or even medical students may be called on in a prolonged and severe disaster." The CMPA noted that licensure matters could become an issue if that were to come to pass. [CMPA]

Canadian astronaut Dr Robert Thirsk, who returns from an extended stint on the International Space Station on December 1, discussed his concern about his vulnerability to the H1N1 flu on his return from space because astronauts are known to have depressed immune responses when they disembark. [Canadian Press]

H1N1-free news
On Tuesday, Quebec's College of Physicians endorsed limited legal euthanasia in some circumstances in a position statement titled "End-of-Life Care: Getting Around the Impasse." The statement said that the question should not be whether euthanasia is right or wrong, but rather whether end-of-life care being delivered is appropriate. "We have to get beyond the logic of current legislation," said College president Dr Yves Lamontagne. "We need to move toward an appropriate care logic and adapt the legislative framework accordingly so that it allows us to reassure patients, physicians and society that the care provided at the end of an individual's life will be as appropriate as possible." [College des médecins news release] "There do exist certain exceptional situations where euthanasia could be considered by the patient and their physician to be an ultimate and necessary step in assuring the patient receives appropriate and quality care to the very end," said Dr Lamontagne. [Toronto Star]

Dr Susan Burlacoff, a Toronto MD who billed $65,000 for treatments she never provided to members of her own family, was cleared of criminal charges of billing fraud by reason of mental illness. Medical experts testified that Dr Burlacoff's psychosis caused her to believe 2,700 insurance claims over a five-year period for visits that never occurred, were valid. She remains in practice. [Toronto Star]

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What's in the news: Oct. 30 -- Some MPs decline the H1N1 flu vaccine

noreply@blogger.com (Sam Solomon) — Fri, 30 Oct 2009 18:04:00 +0000

Some MPs decline the H1N1 flu vaccine
The Hill Times has compiled a list of Members of Parliament who have stated they will not receive the H1N1 flu vaccine: "NDP MP Denis Bevington, Conservative MP Terence Young [the author of the 2007 book Death by Prescription: A Father Takes on His Daughter's Killer], NDP MP Don Davies, Conservative MP Brian Jean."

Mr Davies told the newspaper, "I've never had a flu shot in my life. I'm 46 and I've never had any difficulties. In my time I've seen five separate pandemic scares that have come from legionnaires' disease in the 1970s, to other swine flues, and I generally think that they tend to be overstated, the fears."

"I'm still thinking about whether or not this is a good thing for me," said NDPer Carol Hughes, a member of the Standing Committee on Health. [The Hill Times]

Conservative MP Maxime Bernier has also said he will not be getting the shot. [CBC News: Inside Politics blog]

It's obviously a matter of personal choice, and I don't think anyone would suggest that MPs should be required to receive flu shots, but maybe they should keep quiet about it if they're not going be immunized, especially at a time when public health officials are trying to convince Canadians the shot is safe and important?

More H1N1 flu news
Staff and patients have been infected by an outbreak of the H1N1 flu at Mount Sinai Hospital in Toronto [CBC News] as well as Bridgepoint Hospital. [Globe and Mail] The flu has also hit McGill University's residences. [CBC News]

The Canadian Medical Association is pleading with business owners to follow the government's lead by not asking employees to get sick notes from their doctors to demonstrate that they're unfit to come in to the office. [CMA news release]

mdBriefCase is offering an online CME course for Canadian doctors on the H1N1 flu. [mdBriefCase news release]

Another new online course for health workers, this one offered by Mount Sinai Hospital psychiatrists and nurses, called the Pandemic Influenza Stress Vaccine, instructs on how to manage the anxiety brought on by this wild and crazy flu season. [Pandemic Influenza Stress Vaccine course] [CBC News]

A Nova Scotia doctor who is obviously taking the H1N1 flu more seriously than some of our esteemed Members of Parliament, told an entire family to quarantine themselves. [Halifax Chronicle-Herald]

Did Quebec receive its fair share of H1N1 flu vaccines? The PQ, despite the Liberal health minister's claims otherwise, says no. [La Presse]

Experts from the National Advisory Committee on Immunization recommend the seasonal flu shot still be given to at-risk patients. [Canada Communicable Disease Report, Public Health Agency of Canada]

A Maclean's reporter tracked down a teenager who drinks alcohol-based hand sanitizing gel to get drunk. "The best way to drink hand sanitizer is straight, like whisky, and down it 'like a shot,' explains Tyler, a Grade 10 student who lives in Toronto. Undiluted, the alcohol-based liquid tastes a little like 'vodka and bug spray,' he adds." [Maclean's]

PEI's health minister is annoyed that the College of Family Physicians of Canada scheduled its annual conference during the beginning of the H1N1 flu's arrival this fall because 25 Islander doctors have headed off to Alberta to take part, leaving the province severely depleted of physicians. [Charlottetown Guardian]

And now for the portion of this missive reserved for non-H1N1-flu-related news...
The Canadian Paediatric Society is likely to recommend kids under the age of two not watch television at all, mimicking the American recommendations that have been in place for years. [Ottawa Citizen]

A Q&A with BCMA president Dr Brian Brodie appears in the current issue of the BC Medical Journal. The cover of the current issue has a photo of Dr Brodie astride a horse, in front of a bunch of sheep. He describes a typical day, which involves feeding his poultry and livestock before going to the hospital, and he says, "I'm not interested in wealth —- in fact everything I've read says inherited wealth isn’t good. So the goal is not to leave my kids money or to leave that kind of a legacy. I'd like to give the money away to help others who haven’t had opportunities." [BC Medical Journal] Vancouver Sun health reporter Pamela Fayerman notes that Dr Brodie earned a whopping $529,491 from his family practice alone in the last year for which statistics are available -- "perhaps the highest figure I've ever seen for a family doctor," writes Ms Fayerman. And that doesn't include his farming and real-estate ventures. [Vancouver Sun, Medicine Matters blog]

The College of Family Physicians of Canada named its family physicians of the year for 2009. [CFPC news release (PDF)]

Air Canada has applied for judicial review in the case of Henry Coopersmith. Listen to CBC Radio's Dr Brian Goldman discuss the case on the "White Coat, Black Art" episode originally broadcast on October 17. [CBC Radio's "White Coat, Black Art"] Read more about the case on Canadian Medicine.

Six out of ten provinces saw wait times drop over the past year, according to a new Fraser Institute report. [Fraser Institute news release] [Waiting Your Turn report (PDF)]

Toronto sports medicine specialist Dr Tony Galea had his office raided by the RCMP and is now charged with importing and selling illegal drugs. Dr Galea said the charges stem from a misunderstanding about his use of unlicensed homeopathic medications from Germany that he gives to athletes only with their informed permission. [Globe and Mail]

There's talk that outspoken Quebec MNA and ADQ health critic Eric Caire may leave the party after not being offered the position he wanted following his incredibly close loss in the party's leadership race. [La Presse]

Image: McNally Robinson

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What's in the news: Oct. 28 -- Dal med school on probation: accreditation body

noreply@blogger.com (Sam Solomon) — Wed, 28 Oct 2009 04:00:00 +0000

Dalhousie med school on probation
Dalhousie's medical school is on probation after it failed to attain accreditation from an American auditing body. The school (left) was marked non-compliant in 17 of 132 areas initially but managed to get seven of those overturned. The probation lasts up to two years, but the school is still accredited in the meantime. [Dalhousie Medical School news release] "It's a reputational black mark," Dr Tom Marrie, the school's dean, told the Canadian Medical Association Journal. "The program is still a good program. It’s still accredited." [CMAJ] [Saint John Telegraph-Journal]

H1N1 flu vaccination campaign launch marred by logistics troubles
This week is the first full week of H1N1-flu vaccination in Canada and already there have been problems. Montrealers were supposed to receive doses on Monday but logistical problems for patients and doctors alike caused a minimum one-day delay. The Gazette called Monday a "confusing non-start" but health officials said the problems were just a hiccup. [Montreal Gazette] In Calgary, Monday's vaccine roll-out was marred by similarly frustrating planning, and patients eager to get immunized left long lines without getting the shot. Alberta health minister Ron Liepert absolved himself of responsibility for the difficulties, placing it entirely on his public health staffers. [Calgary Sun] In Ontario, some patients waited as long as three hours to be immunized. [Toronto Star]

MORE NEWS FROM ACROSS CANADA
This year's Chalk River nuclear power plant shutdown, which put a strain on hospitals' supplies of radioisotopes used in diagnostic imaging exams, will delay diagnoses, Canadian Society of Nuclear Medicine president Dr Jean-Luc Urbain told Members of Parliament. "We are not necessarily going to see the effect of the shortage of isotopes today, but we'll see it six months down the road, a year down the road, two years down the road," he said. [Edmonton Sun]

New Brunswick will review 30,000 radiology reports prepared by Dr Bhagwan Jain, who is suspected of having made an unacceptably high number of errors. [CBC News]

Alberta introduced its new pharmaceutical strategy, slashing generic drug prices and promising new fees for pharmacists to make up for the lost income. [Edmonton Journal]

Saskatchewan's Tony Dagnone presented his findings as commissioner of the province's Patients First Review, with a list of recommendations for the government on ways to improve care from the patient's perspective. [Patients First Review report] [Regina Leader-Post] [Saskatoon StarPhoenix]

Taser International, the manufacturer of the controversial stun guns, issued a warning not to fire its weapons at people's chests. In addition to making the use of the weapon safer, the company's bulletin said, the new policy will enhance "the ability to defend such cases in post event legal proceedings." [Taser International safety bulletin (PDF)] [CBC News] The RCMP has already begun to change its policies in accordance with the company's counsel. [CBC News]

The federal government should include healthcare facilities in its stimulus spending, Canadian Medical Association president-elect Dr Anne Doig said, calling the decision not to do so "shameful." "The federal government has chosen not to invest these funds in health facilities, and this is inexplicable," said Dr. Doig. [CMA News]

The CMA launched a new website, ephysicianhealth.com, to aid doctors with addictions and other personal problems. [CMA News]

A Toronto hospital clerk was fired for turning away an uninsured immigrant seven-year-old who was bleeding from a head wound. [Toronto Star]

Prescription opiate abuse is on the rise in British Columbia, according to a new study from UBC. [Canadian Press]

Supervised crack-smoking sites are needed to protect users' health, said BC's public health chief.
[Globe and Mail] [National Post]

The McGill University Health Centre hospital network is now giving out free gym memberships to its breast cancer patients, based on evidence that physical activity is associated with higher cancer survival rates. McGill University researchers will follow the women given gym memberships to add to the medical literature on the subject [MUHC news release]

Doctors are to blame for the lack of access to medical marijuana in Quebec, alleged one prominent medical-marijuana activist. [Le Devoir]

Dr Ray Wiss discussed his Afghanistan experience and his new book on his time there as a physician with the Canadian Forces. [Toronto Star] Dr Kevin Patterson, an author and military veteran who has worked as a civilian physician in Kandahar, reviewed the book favourably. [Globe and Mail] Dr Wiss published some of his diaries last year in the National Review of Medicine, not long after returning from the war. [NRM]

Six physicians and researchers were named to the Canadian Medical Hall of Fame: Alan C Burton, James Hogg, William A Cochrane, Vera Peters, Phil Gold, and Calvin R Stiller. [Canadian Medical Hall of Fame]

Photo: Dalhousie Medical School

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Details of new NB Medical Society deal released

noreply@blogger.com (Sam Solomon) — Tue, 27 Oct 2009 17:18:00 +0000

The terms of the new contract the New Brunswick Medical Society and the provincial government signed last month [Canadian Medicine] have been released: 3.75% per year raises for four years, retroactive to April 1, 2008, followed by a two-year wage freeze from 2012 to 2014. [Government of New Brunswick/NBMS joint statement]

That's a big improvement on what the government initially brought to the negotiating table, which was zero.

In fact, the new deal is one of the two options (1: the initially-agreed-upon four-year contract with a two-year wage freeze preceding it; or 2: the initial deal with a two-year freeze following it) the government presented to the physicians this past summer, before then-health minister Michael Murphy changed his mind, retracted the offer and oversaw the legislature's drafting of a law [Bill 93 (PDF)] that gave the government authority to unilaterally override the original (wage-freeze-free) version of the deal, agreed upon in 2008.

Image: Government of New Brunswick

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Do doctors need "reputation management" lawyers?

noreply@blogger.com (Sam Solomon) — Mon, 26 Oct 2009 04:00:00 +0000

Earlier this month, on the Canadian legal news website Slaw.ca, University of Western Ontario law student Omar Ha-Redeye made a really interesting prediction: one area of the law that's sure to see growth in the future is something he calls "reputation management," and physicians are perhaps chief among the clientele that's likely to demand that service.

Mr. Ha-Redeye uses as a jumping off point for his argument my recent article in Parkhurst Exchange about an Alberta urologist named Mohamed Foda who this year became the first physician anywhere (as far as I can tell) to force RateMDs.com to disclose the names of anonymous reviewers.

The Foda case against RateMDs is tied in with another suit he is involved in in Edmonton and it all gets very complex very quickly, but the long and short of it is that Mr. Ha-Redeye seems to see Dr Foda's successful efforts to fight back against anonymous online libel as one of the first of a forthcoming trend of "reputation management" lawsuits.

What do you think? Are we going to see the development of a new field of reputation management law? Should the Canadian Medical Protective Association be in the business of not only protecting physicians from malpractice suits, as they do now, but also protecting their reputations?

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Canada approves H1N1 flu vaccine

noreply@blogger.com (Sam Solomon) — Wed, 21 Oct 2009 18:18:00 +0000

Arepanrix, GlaxoSmithKline's vaccine against the pandemic H1N1 flu, was today given Health Canada's stamp of approval. "This is a milestone in our efforts to fight the pandemic H1N1 flu virus," Health Minister Leona Aglukkaq said in a statement. "Thanks to careful planning we now have a safe and effective vaccine being distributed to provinces and territories that they will be rolling out in a matter of days."

The Public Health Agency of Canada's vaccination recommendations are as follows:

All Canadians 10 years of age and older should receive one dose of adjuvanted vaccine;
Children from six months and up to 10 years of age should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart;
Children age 0-6 months – immunization not authorized; and
Pregnant women should receive one dose of the unadjuvanted vaccine, of which Canada has ordered 1.8 million doses. In cases where the unadjuvanted vaccine is unavailable and pandemic H1N1 flu rates are high or increasing in the community, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine.

The unadjuvanted version of the vaccine is supposed to be available within a couple of weeks.

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What's in the news: Oct. 16 -- The H1N1 flu's second wave is here

noreply@blogger.com (Sam Solomon) — Fri, 16 Oct 2009 20:11:00 +0000

This month marks the beginning of what appears to be the anticipated "second wave" of the H1N1 flu pandemic in Canada, with clusters of cases appearing once again. [Toronto Star]

As doctors anxiously await the arrival of the vaccine, health officials are busy trying to simultaneously push back against rumours that the vaccine might be dangerous or useless and (so far unsuccessfully, it seems) convince people to wash their hands and stop coughing on one another.

Meanwhile, researchers around the world are still learning more about the virus and the disease it causes.

American government researchers found that people killed by the H1N1 flu have often had bacterial coinfections in their lungs, including with the bacterium pneumococcus. That means the pneumococcal vaccine is an important element in the effort to keep patients safe this flu season, the researchers said. [Morbidity and Mortality Weekly Report] [MedPage Today]

Early use of the H1N1 vaccine in China by the World Health Organization showed some very minor side effects, like headaches and muscle cramps. [Associated Press]

Canada granted drug and vaccine manufacturer GlaxoSmithKline immunity in potential H1N1 vaccine lawsuits. "We're not obviously anticipating problems with it, but indemnification for a vaccine is important if someone does malpractice, basically injects someone the wrong way or causes harm because of their practice," Dr David Butler-Jones, the head of the Public Health Agency of Canada, told reporters. [Toronto Star]

British Columbia came to an agreement with its doctors to pay $14.74 for fielding H1N1-related phone calls. BC physicians should use the billing code PG13705 on their claims. Another new billing code, PG13700, will pay family physicians $31.15 for office visits to deal with the H1N1 flu. Both new fees will cease to be available when the Provincial Health Officer decides they are no longer necessary. [BC Medical Services Plan information on the new H1N1 flu codes for physicians (PDF)] [CBC News]

Contrary to the rumoured results of Canadian research that circulated recently, a new Mexican study suggests the seasonal flu shot might actually aid H1N1 flu immunity rather than encourage it. [British Medical Journal] [Globe and Mail]

It turns out that a Manitoba reserve -- and not the federal government -- was responsible for requesting the large shipment of body bags that was responsible for a major controversy and much mudslinging at Health Canada. [National Post] [Globe and Mail]

Several Winnipeg physicians recommended that doctors should make sure they have enough sedatives and antimicrobials on hand to treat H1N1-flu patients in the ICU. [CMAJ]

Using electronic text messages displayed in public restrooms, British researchers discovered that shame is the most powerful motivator in getting people to wash their hands, more so than reason or disgust. The lesson may be transferable. "A similar method of unobtrusive observation should also work for other kinds of behaviors important to public health, such as smoking cessation and alcohol moderation campaigns." [American Journal of Public Health] [BBC News]

A Prince Edward Island physician surmised that an outbreak of the H1N1 flu virus in the Toronto Maple Leafs dressing room would wreak havoc on the team's ability to win hockey games. "Well," Dr Richard Schabas, the former chief medical officer of Ontario, told the National Post, "at least they are going to have an excuse this time." [National Post]

Image: Shutterstock

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5 ways to deal with online MD ratings

noreply@blogger.com (Sam Solomon) — Mon, 12 Oct 2009 04:00:00 +0000

What’s your recourse when web reviews get ugly?

Much the same way you can review books or rate your kitchen appliances, Canadian patients are busy kibitzing about their doctors online. Although some doctors welcome the feedback, plenty of others can’t stomach the idea of anonymous, unproven accusations made public. What are your options to deal with online reviews?

Click here to read the five ways doctors can handle negative ratings, from Parkhurst Exchange magazine's current issue.

Image: RateMDs.com

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Spotting the scammers

noreply@blogger.com (Sam Solomon) — Fri, 09 Oct 2009 04:00:00 +0000

In Parkhurst Exchange magazine's cover story this month, Brampton GP Alan Russell details the growing problem of drug-scamming patients. "I still wince," writes Dr Russell, "when I think of an empty bottle bearing my name that was found outside a school two days after being filled."

Also in the issue: a Q&A with undercover cop Dave Stinson, of the Toronto Police's prescription-drug trafficking and abuse squad. Mr Stinson -- who had to interrupt the interview at one point to follow a suspect and buy some heroin -- has investigated patient-scammers as well as corrupt doctors, and he helped put away Toronto physician John Kitakufe for eight years.

"I think doctors are in a tough spot. They have confidentiality issues at the highest level. That’s the way our country, our province approaches that, and that’s a good thing -- nobody wants their health records shared with law enforcement. By the same token, as a just society, to quote Trudeau, it shouldn’t and we can’t allow it to be used as a veil to hide criminality. What I'm seeing is an increase in criminality that not only involves the public getting involved -- there is a greater demand than ever before for prescription drugs -- but also healthcare professionals unfortunately acting in a criminal way themselves."

Read the web-exclusive full-length interview here.

The entire October issue is online here, save for a few pieces that you'll have to read in the print version.

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Ontario health minister resigns over eHealth contract scandal

noreply@blogger.com (Sam Solomon) — Thu, 08 Oct 2009 04:00:00 +0000

Ontario Health Minister David Caplan quit on Tuesday as the province's auditor general prepared to make public the results of his office's investigation into "favouritism" and "questionable procurement practices" at the eHealth Ontario agency in the form of contracts doled out without proper competitive bidding.

Deb Matthews (below right), who had been Children and Youth Services Minister and holds a PhD in social demography, has been named to replace Mr Caplan.

Mr Caplan's fall from grace has initiated some grumbling from within the Liberal Party ranks. "None of this happened on his tenure – it's all under George," an anonymous Liberal told the Toronto Star, referring to former health minister George Smitherman, who held the job from 2003 until 2008. "But with the report coming out, David takes the fall and is a good soldier."

Rumours have circulated already that Mr Smitherman was spared from accepting blame for the eHealth mess because he's a likely candidate (and likely winner) in the upcoming election for the Toronto mayoralty. And, as the rumours go, Premier Dalton McGuinty would benefit greatly from having an ally in Toronto City Hall.

But the auditor general's new report shows that theory of Mr Caplan's innocence and Mr Smitherman's guilt to be false. The vast majority of contracts awarded without competitive bidding were awarded by eHealth CEO Sarah Kramer, who ran the agency from November 2008, four months after Mr Caplan began as health minister, until she was booted from the job this past summer. The report also blames the health ministry for failing to provide proper oversight and direction in 2008 and 2009.

When I spoke to Mr Caplan in May about his work as minister of health, his ambition was clear. "I commented on June the 20th [in 2008], or around then when we had the swearing in, that my goal was to be the second best minister of health the province has ever had. I was not referring to Minister Smitherman, although he is a good friend and I have great admiration. My mother, 20 years ago, was a minister of health for the province of Ontario and, in my opinion, the very best one."

Although he surely wasn't the only one at fault for the eHealth scandal, Mr Caplan will now nevertheless have to resign himself to the idea that history won't see him quite as he had hoped.

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What's in the news: Oct. 1 -- Gay man takes on blood-donor ban

noreply@blogger.com (Sam Solomon) — Thu, 01 Oct 2009 04:00:00 +0000

Gay man takes on blood-donor ban
A gay blood donor has begun a major and potentially majorly consequential legal battle with Canadian Blood Services over their prohibition on male homosexual donations. CBS is suing Kyle Freeman of Thornhill, Ontario, for lying about his status as an eligible donor and for donating blood in violation of its rules, and Mr Freeman is suing CBS, alleging their policy banning gay men from being donors is a violation of his Charter rights. [Ottawa Citizen] [Sun Media]

Unpublished data dictate Canadian flu-vaccine policy
Most provinces are now suspending their seasonal-flu vaccination programs after word circulated of several as-yet-unpublished Canadian studies that reportedly found the seasonal vaccine raises the risk of contracting the pandemic H1N1 strain. Only New Brunswick has committed to distributing seasonal vaccine, reported The Globe and Mail. [Globe and Mail]

Military considers requiring H1N1-flu vaccine
The Canadian Forces is worried about the legality of mandating the H1N1-flu vaccine for its soldiers. [CTV News]

OMA lobbies against pharmacists prescribing
At a legislative committee hearing on Tuesday, the Ontario Medical Association issued a salvo in its push back against the Ontario government's proposal to permit pharmacists to prescribe some drugs and renew some scripts. "The number one priority for Ontario's doctors throughout this entire process has been and remains patient safety because the level and quality of care that a doctor can provide should not be substituted for expediency," President-elect Dr Mark MacLeod said in a release. [OMA news release]

Report cards are in
The Conference Board of Canada ranked Canada 10th out of 16 developed countries on its healthcare systems, giving it a 'B' grade. The United States ranked 16th, with a 'D.' [Conference Board of Canada report] [CBC News]

Asklepios hits 3,000 members
The Canadian Medical Association's online social network has 3,000 members a little over one year after its launch. [CMA News]

Drugs bought online kill drug researcher
A Canadian neurobiology post-doc working in Maryland is to face criminal charges after his girlfriend died from a buprenorphine overdose as a result of recreational use of what may have been tainted drugs that were acquired from overseas via the internet. [Associated Press]

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What's in the news: Sep. 28 -- Who gets treated first in a pandemic?

noreply@blogger.com (Sam Solomon) — Mon, 28 Sep 2009 04:00:00 +0000

Who goes first?
Hamilton Health Sciences announces Canada's first priority-treatment plan for the H1N1 flu pandemic. [Hamilton Spectator] According to The Spectator, the priority list is as follows:

1. Health-care workers and other essential services such as firefighters and police officers because they have the skills to save others once they're better.

2. Those who caught the flu at work, particularly essential service workers, because they put themselves at risk to save others.

3. Caregivers of children, disabled adults or the elderly to minimize societal disruption.

4. Young people because they haven't had a chance to live their lives yet.

5. Those most likely to survive that particular strain of flu.

An HIV vaccine or another dashed hope?
Thai researchers announced encouraging results from a set of HIV-vaccine trials. The combo-vaccine that was being tested proved effective in 31% of patients, and many experts were cautious in expressing optimism about the first-ever positive results in an HIV-vaccine trial. [Globe and Mail]

No flu shots until puzzle resolved
Ontario health officials said they would delay distributing regular flu shots because as-yet-unpublished research has indicated that the regular flu shot may raise the risk of contracting the H1N1 flu. [Canadian Press] [CTV News] [Canadian Press]

NB finally fills trauma chief job
The province of New Brunswick has hired Dr Marcel Martin, a surgeon from Sherbrooke, Quebec, to run its trauma-care system, after an interminably long period in which no progress was made on trying to hire someone for the job. [CBC News]

Alberta political shakeup to come?
The right-wing Wildrose Alliance party could pick up as many as 10 Progressive Conservative defectors if leadership candidate Danielle Smith wins the primary election, the Edmonton Journal's Trish Audette reported. [Edmonton Journal] That would dramatically alter the provincial political scene, which has been dominated by the Tories since the Mesozoic Era or thereabouts. And as complaints about the size and nature of government spending on healthcare continue to plague the Stelmach government from the left, the right and the centre, it seems fair to say that the province's divisive health reform being ushered in by Health Minister Ron Liepert may be playing a big part in voters' disillusionment with the Conservatives. Then again, maybe it's just that oil and gas tax revenues are down. When the price of oil rises again, voters may forget their complaints about the Tories' management.

Photo: Shutterstock

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What's in the news: Sep. 24 -- New Brunswick and MDs patch things up

noreply@blogger.com (Sam Solomon) — Thu, 24 Sep 2009 04:00:00 +0000

MDs vs. NB conflict at at end?
New Brunswick and its doctors have reached an agreement in principle on how to deal with the raise that was offered by the government and then rescinded when it became apparent that the recession would cause revenues to fall short of where they were predicted to be. The medical association's announcement, however, did not make clear whether the new agreement in principle would reinstate the raises or would grant the government some of its cuts. [New Brunswick Medical Society] [CMA News] The doctors' union was supposed to go court against the provincial government last week to try to force the government to honour a new collective agreement (including a significant raise) it offered and then refused to sign, but the two camps then came to an 11th-hour agreement to return to the bargaining table. [CMA News] Read more about the dispute on Canadian Medicine.

Extra H1N1-flu pay for doctors?
Physicians in several provinces -- Alberta [Edmonton Sun], Saskatchewan [Canwest News Service], and others as well -- are asking governments to pay them extra for treating H1N1 flu patients. The BC Medical Association is asking for a new fee for fielding phone calls from patients concerned they may have the flu. Manitoba and PEI are reportedly not considering any new payments for the H1N1 pandemic. [National Post] Nova Scotia's physicians are working on a plan with the provincial government to insure them against potential income losses as a result of the pandemic. [Halifax Chronicle-Herald]

Docs do drugs to stay awake
Ever wonder how doctors manage to stay awake and alert enough on emergency-department night shifts to be able to respond at a moment's notice and be ready to make life-or-death decisions? Toronto emergency physician Brian Goldman, the host of CBC Radio's White Coat, Black Art confesses to using a drug called modafinil to keep himself alert, just as other doctors do. "Frankly, my colleagues have been far too silent about how difficult they find it to stay awake and alert," he wrote recently. "In being silent, they may have given you the erroneous impression that the problem is being taken care of, and that it's nothing you need to worry about." Listen to an MP3 of the September 12 episode here or listen to Dr Goldman's discussion with a colleague about their drug use here.

MORE NEWS FROM ACROSS CANADA AND BEYOND
Quebec will provide H1N1 flu vaccines free to residents but may cancel its regular flu shots this year in favour of delivering H1N1 flu shots. [CBC News]

New guidelines from the Canadian Paediatric Society recommend doctors adopt watchful waiting more frequently than jumping right to antibiotics when it comes to kids' ear infections. [Canadian Press] [Full guidelines available free online from the journal Paediatrics and Child Health]

Nova Scotia's Apology Act comes into effect on the first of October. [CBC News] [Read the new law: Bill 233]

Newfoundland doctor Brenda Penney has threatened to leave Lewisporte, NL, if provincial health minister Paul Oram follows through on his plans to move laboratory services out of the town. [CBC News]

The recently elected NDP government of Nova Scotia hired the controversial MD -- the man declared a mass casualty alert at his Halifax hospital last year when wait times got unmanageably long, in a move that embarrassed the now-deposed Progressive Conservative government -- to improve the province's emergency departments. [Canadian Press]

Dr Eric Hoskins, a co-founder of War Child Canada along with his wife Dr Samantha Nutt, a former federal Liberal candidate, and a former government policy adviser, won a seat in the Ontario Legislative Assembly running as a Liberal. [CTV News]

A fascinating interview with a German military MD who worked in Afghanistan. [Der Spiegel] (Don't worry: it's not in German.)

Flag: Government of New Brunswick

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"A joke": A progressive's view of US health reform

noreply@blogger.com (Sam Solomon) — Tue, 22 Sep 2009 04:00:00 +0000

If you've somehow managed to avoid hearing the news about what's been going on lately with the US effort to reform the country's health-insurance and healthcare systems, an impassioned article by Rolling Stone's Matt Taibbi provides a good look at the progressive perspective on recent events.

We might look back on this summer someday and think of it as the moment when our government lost us for good. It was that bad. [...]

All that's left of health care reform is a collection of piece-of-shit, weakling proposals that are preposterously expensive and contain almost nothing meaningful — and that set of proposals, meanwhile, is being negotiated down even further by the endlessly negating Group of Six. It is a fight to the finish now between Really Bad and Even Worse. And it's virtually guaranteed to sour the public on reform efforts for years to come. [...]

It's a joke, the whole thing, a parody of Solomonic governance. By the time all the various bills are combined, health care will be a baby not split in half but in fourths and eighths and fractions of eighths.

It's really worth taking the time to read the whole thing. And keep in mind that Mr Taibbi's article came out a few weeks ago, before Senator Max Baucus's Group of Six decided to altogether eliminate the public option from its proposed legislation (PDF).

Illustration: Rolling Stone

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Maximize your practice's revenue

noreply@blogger.com (Sam Solomon) — Mon, 21 Sep 2009 04:00:00 +0000

Forget trying to scale back your overhead — focus on your income

A south-central Ontario group practice did some reorganizing and realized they had an 800-square-foot surplus of office space. They’d already committed to a mortgage on the building, and finding a new doctor to join their group was proving difficult. What to do?

The answer, provided by Practice Solutions consultant Jim Sweeney, was to rent out the surplus office space to other health professionals — in this case, a team of physiotherapists. “This was a win-win opportunity,” says Sweeney, a 37-year veteran of practice management consulting. The group practice got rid of the drag on their finances, while the physiotherapists got access to an office that was already set up for patients.

Renting out extra office space (or even your own office space during hours it goes unused) to ancillary medical services providers or to other doctors, is one of the most effective ways to maximize your practice’s revenue, says Sweeney.

For most physicians, expenses are already as low as they can reasonably go. Unless your staffers are earning outrageous salaries or your waiting room is so lavish that patients just come in to relax, you probably don’t have much fat to trim. That’s why if you want to offset your overhead you’ll have to look at maximizing your revenue, either via new sources (like renting out unused office space) or through existing channels. The most fruitful thing you can do with your existing revenue stream, says Sweeney, is to optimize your billing.

Read the rest of this Practice Management article, which appears in the September issue of Parkhurst Exchange magazine, online here.

Photo: Shutterstock

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What's in the news: Sep. 18: The latest on the H1N1 flu in Canada

noreply@blogger.com (Sam Solomon) — Fri, 18 Sep 2009 04:00:00 +0000

Will the H1N1 flu vaccine be available too late to protect some Canadians? [Toronto Star]

On the bright side, it appears that one dose of the vaccine, as opposed to the two doses that were inefficiently predicted to be required, will be sufficient to confer protection. [MedPage Today] [NEJM study] [Another NEJM study] [And yet another NEJM study]

Dr Kumanan Wilson, the Canada Research Chair in Public Health Policy, at the University of Ottawa, discussed why young Canadians don't want the vaccine. [Globe and Mail]

The current issue of the Canadian Journal of Infectious Diseases & Medical Microbiology has several articles on the H1N1 flu of interest to clinicians, including one on treating kids, one on what we've learned so far about the pandemic virus, and one about the work that went into preparing for this outbreak. See the journal's TOC here.

The hot topic this week is the story out of Manitoba about accusations that Health Canada shipped body bags to First Nations reserves in preparation for this fall or winter's second wave of the flu. Federal health minister Leona Aglukkaq, an Inuit from Nunavut, is on the hot seat and has promised an investigation, while a Health Canada bureaucrat denied the shipment had anything to do with the flu. [Canadian Press] The story sure looks bad for Health Canada, which earlier this year delayed sending alcohol-based hand disinfectant gel to Manitoba reserves because of concerns in Ottawa that people there would try to eat the gel to get drunk. "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, said at the time. [Canadian Medicine]

A second case of drug-resistant H1N1 flu was identified in Canada. The first was in Quebec; this one is in Alberta. [Canadian Press]

New research has revealed some bad news: the H1N1 flu virus is contagious longer than was previously thought. Quebec researchers determined that 15% of patients infected with the H1N1 strain were still contagious on the eighth day of their infection, but that no one was contagious on the eleventh day. [Fonds de la recherche en santé du Québec news release]

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Canadian Medicine named finalist for publishing award

noreply@blogger.com (Sam Solomon) — Thu, 17 Sep 2009 04:00:00 +0000

Canadian Medicine has been selected as a finalist for the Canadian Online Publishing Awards "Best Blog" category in the trade publications division.

We'd like to say we're humbled by the news but that seems a bit disingenuous considering we're right now drawing your attention to it. Let's just say it's nice to be noticed.

Winners will be announced Monday, October 26 at a reception in Toronto at the Gladstone Hotel, 1214 Queen Street West. Tickets for the event cost $10.

This is the Canadian Online Publishing Awards' first year. The competition is being overseen by Masthead Magazine.

(And, as an addendum, I'd like to preemptively acknowledge before any skeptical readers get any funny ideas that yes, I was a judge for the awards but no, I didn't judge the category Canadian Medicine was in.)

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Federal jokesters mine H1N1 flu for new material

noreply@blogger.com (Sam Solomon) — Wed, 16 Sep 2009 18:27:00 +0000

Thanks to Maclean's reporter Aaron Wherry for subjecting himself to Question Period in the House of Commons yesterday so the rest of us didn't have to. He asks that we take note of one "particularly edifying exchange":

Ms. Judy Wasylycia-Leis (Winnipeg North, NDP): Mr. Speaker, the A (H1N1) flu is expected to hit even harder in October. Some 74 people have already died from this flu virus. We need to act now. The minister plans to reveal her priority list for the flu vaccine a little later this week, but we want to know now whether first nations and Inuit people are on that list, since they are at a much greater risk. My question is very simple. Can the minister tell us whether aboriginal people are on the government's list of priorities?

Hon. Leona Aglukkaq (Minister of Health, CPC): Mr. Speaker, I want to be very clear that every Canadian who wants to receive the vaccine will receive it. The vaccine rollout is currently being developed. A special advisory committee made up of chief medical officers is working on that and I expect that vaccine rollout document to be released some time this week. We are working with the provinces and territories to ensure that all Canadians who want to receive the vaccine will be able to do so.

Ms. Judy Wasylycia-Leis (Winnipeg North, NDP): Mr. Speaker, does the minister realize that “A (H1N1)” is not a postal code? We have a serious problem on our hands. At the symposium in Winnipeg two weeks ago, leading epidemiologists in this country said that first nations and Inuit people are 25 times more likely to contract H1N1. I ask you, Mr. Speaker, is the government going to stop the bureaucratese and this dilly-dallying with respect to first nations and Inuit people and act now?

Hon. Leona Aglukkaq (Minister of Health, CPC): Mr. Speaker, the only party that thinks H1N1 is a postal code is that party. Our goal is to ensure the balance between the needs and the speed of the timing of the vaccine. We are gathering as much information as we can on the vaccine to ensure that it is safe and effective for all Canadians. Thanks to the actions of Health Canada, we will be able to approve that vaccine quickly and all Canadians who want to receive the vaccine will be able to do so.

Just in case that conversation got you wondering, we pay Members of Parliament a base salary of $157,731 a year. Ms Wasylycia-Leis, as vice-chair of the Standing Committee on Health, is entitled to an additional $5,684. Ms Aglukkaq gets an extra $75,516 for her efforts as a cabinet minister, plus a $2,122 car allowance.

When children misbehave, their parents usually take away their allowance, don't they? Sometimes Question Period makes you think the inmates are running the daycare, so to speak.

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Get ready for the H1N1 flu's second wave: Butler-Jones

noreply@blogger.com (Sam Solomon) — Fri, 11 Sep 2009 04:00:00 +0000

The good news is that the vast majority of the pandemic H1N1 flu cases in Canada have been mild and the number of fatalities has been held to fewer than 70 as of late summer. The bad news is that we probably haven't seen the worst of it yet.

Dr David Butler-Jones, the nation's first Chief Public Health Officer, is leading the Public Health Agency of Canada's preparations for the anticipated second wave of pandemic H1N1 flu, expected to arrive this fall with the potential to cause far greater damage than the virus has caused so far. He spoke with Parkhurst Exchange about what physicians need to know.

To read the online-only full version of the Q&A, click here.

Photo: Public Health Agency of Canada

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Good or bad? Assessing recessions' health effects

noreply@blogger.com (Sam Solomon) — Thu, 10 Sep 2009 04:00:00 +0000

Is a recession good or bad for people's health?

Readers of Canadian Medicine have already had a taste of this question, in two recent articles: last month in "Economic turmoil is hurting Canadians' health: CMA" and then this month in "Maybe the recession was good for healthcare, after all". In the former, we cited a survey in which Canadians self-reported cutbacks on out-of-pocket health and nutritional spending and exercise. And in the latter, we noted a recent infusion of cash to healthcare infrastructure via federal stimulus spending.

So which is it: a recession is healthful or a recession is harmful?

Well, that very question is examined in a new review published this month in the Canadian Medical Association Journal by University of Washington public-health professor and emergency physician (and University of Toronto grad) Dr Stephen Bezruchka (right), who found that "contrary to what might have been expected, economic downturns during the 20th century were associated with declines in mortality rates."

Dr Bezruchka's paper is worth a full read, but I'll point out for you a few of the most interesting items in the paper:

The "procyclical" (positively related) relationship between recession and decreased mortality rates was less pronounced in countries like the United States and Canada which spend less than many European nations on social programs.
"Health care has not been found to be a major factor in producing health in populations."
This is a simplification of his point, but in essence he posits that higher unemployment = less money = less money to buy cigarettes and alcohol with, and less overeating. (This logic seems questionable to me, but it's something to ponder nonetheless.)
Work can be stressful, and unemployment can relieve pregnant women's stress. (Highly questionable, in my opinion.)
Is Dr Bezruchka a socialist? See especially his assertion that redistributing wealth from rich countries to poor ones would actually be of longterm benefit to the health of everyone, from countries both rich and poor, and the claim that the "current economic crisis offers an opportunity for rich countries to rethink the social purposes of their economies."

Photo: University of Washington

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Maybe the recession was good for healthcare, after all

noreply@blogger.com (Sam Solomon) — Wed, 02 Sep 2009 04:00:00 +0000

There's been no shortage of criticism of the way the federal government has handled the economic stimulus and deficit-spending strategies, but here's an example of really a healthful stimulus: Health Minister Leona Aglukkaq just announced $135 million in new funding for construction and renovation of healthcare infrastructure in First Nations communities.

"This critical investment means new and refurbished health centres and nurses' residences for many of the remote and isolated First Nations communities served by Health Canada, and will provide immediate economic benefit by creating employment opportunities in those areas," she said in a release.

Health Canada's funding to its First Nations and Inuit Health branch was $2.2 billion at last count (accounting for nearly 52% of Health Canada's budget), which means that an extra $135 million for infrastructure is not an inconsequential amount. To give you a sense of how it compares to the department's other programs, $135 million is around half of a typical year's expenses on Health Products and Food for the entire country.

Photo: Government of Canada

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Publishing Rorschach info lands SK doc in hot water

noreply@blogger.com (Sam Solomon) — Mon, 31 Aug 2009 04:00:00 +0000

Most complaints against rural Saskatchewan doctors go unremarked upon in the pages of the United States's paper of record, the New York Times. But not the ones just recently filed with the provincial regulatory college against Moose Jaw emergency physician James Heilman.

According to the Times article, two psychologists have filed complaints against Dr Heilman because he added to Wikipedia the ten famous Rorschach inkblots and common responses and interpretations of those responses -- images and information which some think should have been kept secret from patients to preserve the test's viability. (It should be noted that the images are in the public domain, and Dr Heilman has done nothing illegal.)

It's a fascinating situation. Can the test really be rendered impotent by the publication of the images online? Is Dr Heilman's decision to expand public understanding unethical because of the consequences some psychologists allege it may have? Are those allegations reasonable? Is this Rorschach matter somehow distinguishable from, say, the publication of DSM diagnostic criteria, particularly the criteria that could conceivably garner patients prescriptions to powerful drugs?

None of these are easy questions to answer, but they may be important ones to address as patients increasingly consult the internet about medical questions, and other privileged professional information makes its way online.

For those who are interested, this is the Wikipedia page where the inkblots and information bout them appear. An entire page at Wikipedia is devoted to debating the inclusion of the images, and itself some interesting material to think about.

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Will climate change make medical conferences unethical?

noreply@blogger.com (Sam Solomon) — Fri, 28 Aug 2009 04:00:00 +0000

A new essay by Simon N Young, PhD, a McGill professor of psychiatry, argues that, because of the threat of climate change, doctors must rethink whether they really need to travel to distant venues to attend medical conferences.

Dr Young writes,

"I have noticed that attendance at meetings in cities such as Kyoto and Florence is much higher than at meetings in ... I do not want to get into trouble so I had better let you fill in your own candidates for dull cities. This raises the possibility that research is not always the only motive for attending meetings."

He acknowledges that getting his colleagues to change their behaviour will not be easy. Dr Young illustrates that point by way of an example from his department at McGill.

"In a recent committee meeting I attended, one of the committee members pointed out that the academic under discussion had an excellent publication record but had unfortunately given hardly any presentations at international meetings. When I pointed out that this was not an issue given the carbon footprint involved in attending meetings the committee members all laughed, which I thought ironic given that the area of specialization of the candidate dealt with aspects of moral responsibility. I had to get quite assertive to convince them that I was serious."

The essay appears in the current issue of the Journal of Psychiatry and Neuroscience. Read the full thing here (PDF).

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